Working from findings in the landmark TAILORx study, reseachers estimated that Oncotype DX-guided treatment could reduce the total first-year breast cancer care by nearly $50 million across the United States.
Personalized breast cancer treatment based on genetic profiles of tumors could lower US healthcare costs by nearly $50 million within the first year of care, according to a study in the Journal of the National Cancer Institute.
The study, released Wednesday, was conducted by Georgetown Lombardi Comprehensive Cancer Center and examined the impact that results of the landmark Trial Assigning IndividuaLized Options for Treatment (Rx), or TAILORx, could have on total healthcare costs.
TAILORx, demonstrated the benefit of endocrine therapy alone in patients with early-stage breast cancer who had Oncotype DX Breast Recurrence Scores (RS) between 11 to 25. The addition of chemoendocrine treatment was determined not to be necessary for women with RS scores under 26 and could result in overtreatment. The findings could potentially spare 70% of women with the most common type of breast cancer from needing chemotherapy. Chemotherapy could be avoided in women with early-stage breast cancer that was estrogen receptor and progesterone receptor positive, human epidermal growth factor receptor 2 negative, and had not spread to the lymph nodes.
Researchers used data from Surveillance, Epidemiology and End Results (SEER), SEER-Medicare and SEER-Genomic Health Incorporated datasets to estimate rates of Oncotype DX testing and chemotherapy treatment in addition to mean initial costs pre- and post- TAILORx, assuming women who were tested would receive score-suggested therapy after the trial. Sensitivity analyses examined how costs could be affected by assumptions about compliance with testing and score-suggested treatment as well as estimation methods.
Researchers reviewed statistics on the use of chemotherapy and gene testing in National Cancer Institute and Medicare databases both before and after the results of TAILORx were released. The study only predicted costs of diagnosis and treatment rather than continual or terminal costs.
"Individual women's decisions should not be about dollars and cents, but what is right for them based on consideration of the best evidence and personal preferences," said Jeanne S. Mandelblatt, MD, MPH, professor of oncology and medicine at Georgetown Lombardi in a statement.
During analysis, Oncotype DX test costs were estimated to be nearly $3400 based on Medicare reimbursement rates. It was predicted that pretrial mean initial costs for chemotherapy and Oncotype DX texting would be $2.816 billion. Posttrial, Oncotype DX testing costs were projected to increase from $115 million to $231 million. However, chemotherapy use was expected to decrease from 25% to 17%. Researchers projected that the combined treatment and testing costs would decrease from $2.816 to $2.766 billion. The total net savings were estimated to be above $49 million.
Chemotherapy is substantially more costly than gene testing. In the study, the projected savings were based on total chemotherapy costs and Oncotype DX testing costs. Assuming Oncotype DX testing would be conducted for all newly diagnosed women, a 50% increase in costs, totaling $116 million, was expected. However, it would be offset by the anticipated 8% drop in the overall costs of chemotherapy, totaling $338 million, as it would be required by fewer women.
Most possible assumptions that researchers speculated resulted in net savings. The only exception was if all women 50 years old or younger with tumors and RS scores between 16 to 25 opted to receive chemotherapy, initial care costs could increase by $105 million.
Researchers suggest that further studies are required to evaluate the long-term costs and non-monetary benefits of personalized cancer care.
"This study only answers the question about whether, in the first 12 months after diagnosis, costs of gene testing are likely to be offset by savings in avoided costs of chemotherapy, and the answer is yes. We did not estimate how the trial results could diffuse into medical practice, since those data will not be available for several years. The gene tests are not perfect predictors of who will ultimately have a recurrence of breast cancer, so it will be important to model the long-term outcomes and costs from diagnosis to death,” Mandelblatt said.
Mariotto A, Jayasekerea J, Petkov V, et al. Expected monetary impact of Oncotype DX score-concordant systemic breast cancer therapy based on the TAILORx Trial [published online April 24, 2019]. J Natl Cancer Inst. doi: 10.1093/jnci/djz068.