Patients with high-risk breast cancer who receive a 21-gene assay genomic test may be able to avoid chemotherapy and ultimately save a significant amount of money.
Recurrence score (RS) testing that uses the 21-gene assay decreases cancer care costs for certain patients with breast cancer by allowing them to avoid receiving standard chemotherapy, according to a new study in Journal of the National Comprehensive Cancer Network.
The study found the RS test can help predict if a patient with nonmetastatic breast cancer might benefit from adjuvant chemotherapy. The reduction in use of chemotherapy was directly associated with a spending reduction of $3600. Overall, women who underwent RS assessment had costs that were approximately $6600 less than those of women who were not tested.
The authors analyzed associations between RS testing and observed costs to Medicare. They studied 30,058 patients with breast cancer between ages 66 and 75 years to determine total and chemotherapy-specific costs in the year after diagnosis. Of the patients included, 17.5% received RS testing, with patients receiving testing more likely to be younger and have no comorbid conditions. People who were tested were also more likely to have intermediate-risk disease (69.5% vs 43.9%) than low-risk disease (17.2% vs 28.7%) or high-risk disease (13.3% vs 27.4%) compared with patients who did not receive RS testing.
With RS testing costing an average of $3217, patients who were tested had slightly higher overall costs in the year after their diagnosis than those who did not receive RS testing ($38,054 vs $35,491). In patients with high-risk disease, RS testing was associated with lower costs by about $6600. However, the cost was higher for patients with intermediate- and low-risk disease who received RS testing ($5568 and $9462 higher, respectively). Despite these higher overall costs, there was no differences in the average cost for chemotherapy among these 2 groups.
“This study demonstrates that RS testing provides the greatest reduction in costs among patients who, prior to the test, had the highest likelihood of receiving chemotherapy to begin with,” Michaela A. Dinan, PhD, Duke University, said in a statement. “In the big picture, the ability for RS testing to reduce either the cost of chemotherapy or total health costs may depend on the general distribution of patients who are clinically considered to be high-, intermediate-, or low-risk. This knowledge should help inform a provider’s decision about when RS testing may be most likely to influence treatment choices.”
Some of the limitations of the study included the population age of the patients analyzed. With only patients older than 65 years included, the study missed more than half of all newly diagnosed cases of breast cancer.
“Taken together, our results support the ability of RS testing to reduce chemotherapy costs in real-world practice among patients for whom receipt of chemotherapy is the default treatment paradigm,” the authors concluded.
Dinan MA, Wilson LE, Reed SD. Chemotherapy costs and 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2005 to 2011. J Natl Compr Canc. 2019;17(3):245-254. doi: 10.6004/jnccn.2018.7097.