Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland

• Published in: Breast cancer research and treatment 2015-10, Vol.153 (3), p.573-582
• Main Authors: Smyth, Lillian, Watson, Geoff, Walsh, Elaine M., Kelly, Catherine M., Keane, Maccon, Kennedy, M. John, Grogan, Liam, Hennessy, Bryan T., O’Reilly, Seamus, Coate, Linda E., O’Connor, Miriam, Quinn, Cecily, Verleger, Katharina, Schoeman, Olaf, O’Reilly, Susan, Walshe, Janice M.
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - epidemiology; Breast Neoplasms - genetics; Breast Neoplasms - therapy; Cancer genetics; Cancer research; Cancer therapies; Chemotherapy; Clinical Decision-Making; Clinical Trial; Cost-Benefit Analysis; Cross-Sectional Studies; Economic aspects; Economic impact; Female; Gene Expression Profiling - economics; Gene Expression Profiling - methods; Genes; Genetic testing; Health economics; Humans; Ireland - epidemiology; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Staging; Oncology; Receptors, Estrogen - genetics; Retrospective Studies; Surveys; Tomography, X-Ray Computed; Transcriptome; Tumor Burden
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-015-3555-4

The 21-gene test is a validated multi-gene diagnostic test that predicts chemotherapy (CT) benefit in oestrogen receptor positive (ER+), lymph node-negative (N0) breast cancer (BC) patients (pts). Ireland was the first public health care system to reimburse this test in Europe. Study objectives were to assess the impact of this test on decision-making and to analyse the economic impact of testing. Between October 2011 and February 2013, a national, retrospective, cross-sectional observational study of ER+, N0 BC pts tested with the 21-gene test was conducted. Surveyed breast medical oncologists, provided the assumption for the decision impact analysis that grade (G) 1 pts would not have received CT before testing and G2/3 pts would have received CT before testing. Descriptive statistical analyses were performed. 592 pts were identified; Low, intermediate and high recurrence score were identified in 53, 36 and 10 % pts, respectively. 384 (70 %) pts had G2, 129 (22 %) G3 and 76 (13 %) G1 tumours. Post testing, 345 pts (59 %) experienced a change in CT decision; 339 changed to hormone therapy alone and 6 advised to receive CT. 172 (30 %) pts received CT, 12 (3.9 %) of pts with low scores, 108 (50.9 %) of intermediate risk and 50 (90.9 %) of pts with high risk scores. Net reduction in CT use was 58 % and net savings achieved were €793,565. Since public reimbursement, the introduction of the 21-gene test has resulted in a significant reduction in chemotherapy administration and cost savings for the Irish public healthcare system.