Genetic Testing

A new study suggests that Oncotype DX-guided treatment could reduce the cost for the first year of breast cancer care; in the U.S. by about $50 million (about 2% of the overall costs in the first year). The study by Georgetown Lombardi Comprehensive Cancer Center and National Cancer Institute researchers was publishing April 24; in the Journal of the National Cancer Institute.
The landmark TAILORx (Trial Assigning IndividuaLized Options for Treatment) trial results suggested that use of the Oncotype DX gene test; can offer women valuable information about treatment options, potentially sparing 70% of women from needing chemotherapy; but if they are newly diagnose with the most common subtype of breast cancer. The information only applied to women with early-stage breast cancer that is hormone positive (ER/PR+); HER2neu negative, and has not spread to the lymph nodes.
The projected cost savings in the new study are based on two factors: about a 50% increased cost in gene testing assuming; that it will be done for all newly diagnosed women; which would be offset by an approximately 8% expected drop; in the overall cost of chemotherapy due to fewer women being recommended this form of treatment. Chemotherapy is considerably more expensive than gene testing, hence the 8% reduction in its cost is greater; dollar-wise, than the 50% increase in cost for gene testing.

Newly diagnosed women

“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,” says Jeanne S. Mandelblatt, MD, MPH, professor of oncology and medicine at Georgetown Lombardi.

Mandelblatt and her colleagues examined the monetary impact in the U.S. of providing care based on evidence from TAILORx. The researchers looked at statistics on gene testing and chemotherapy use in National Cancer Institute and Medicare databases; before and after the TAILORx trial results were announce in 2018. The periods during which costs accrue are usually group into three timeframes; initial costs (diagnosis and treatment), terminal costs (last year of life) and everything in between (continuing care costs). This study only estimated initial costs.
The estimated individual Oncotype DX test costs in this analysis were about $3,400 and based on Medicare reimbursement rates. Many insurers, including Medicare, cover the cost for most women diagnosed with early-stage breast cancer. Another gene test using less often in the U.S., called MammaPrint, has similar costs.

Oncotype DX testing costs

The investigators estimated that, prior to 2018, the mean initial costs of healthcare; nationwide for newly diagnosed women with breast cancer; which were fairly stable for a number of years, included two components; chemotherapy costs of $2.701 billion and Oncotype DX testing costs estimating to be $115 million; for a total healthcare cost of $2.816 billion in the first year after diagnosis. The researchers estimated that only 34.8 to 57.2% of women; were receiving the Oncotype DX testing in this period as the clinical application of such tests was still uncertain.
In 2018, the TAILORx findings showed no benefit from chemotherapy for women; whose tumors had lower risks for recurrence based on Oncotype DX scores. For their modeling, the researchers projected that all women with scores of 0-25 (low to intermediate risk) would forgo chemotherapy starting in 2018, so those treatment costs would go down by 8 percent, saving $338 million in initial chemotherapy costs. The researchers also assumed 100 percent of women would get Oncotype DX testing, raising those costs by $116 million (from $115 to $231 million). The total initial costs for this period were therefore projected to be $2.766 billion.