Expected Monetary Impact of Oncotype DX Score-Concordant Systemic Breast Cancer Therapy Based on the TAILORx Trial
Menée à partir des données des registres américains des cancers, des données de l'assurance-maladie Medicare et de la société Genomic Health portant sur 96 529 puis 67 563 patientes atteintes d'un cancer du sein HR+ HER2- et âgées de 15 à 74 ans, cette étude estime, en s'appuyant sur les résultats de l'essai TAILORx, l'effet de l'utilisation généralisée du test Oncotype DX sur le taux de chimiothérapie adjuvante et les coûts associés
Background : TAILORx demonstrated that women with node negative, hormone receptor-positive, HER2-negative breast cancers and Oncotype DX recurrence scores (RS) of 0-25 had similar 9-year outcomes with endocrine vs. chemo-endocrine therapy; evidence for women <50 and RS 16-25 was less clear. We estimated how expected changes in practice following the trial might affect US costs in the initial 12-months of care (“initial costs”).
Methods : Data from Surveillance, Epidemiology and End Results (SEER), SEER-Medicare, and SEER-Genomic Health Inc. datasets were used to estimate Oncotype DX testing and chemotherapy rates, and mean initial costs pre- and post-TAILORx (in 2018 dollars), assuming all women received Oncotype DX testing and score-suggested therapy post-trial. Sensitivity analyses tested the impact on costs of assumptions about compliance with testing and score-suggested treatment, and estimation methods.
Results : Pre-trial mean initial costs were $2.816 billion. Post-trial, Oncotype DX testing costs were projected to increase from $115 million to $231 million, but chemotherapy use to decrease from 25% to 17%, resulting in initial care costs of $2.766 billion, or a net savings of $49 million (1.8% decrease). A small net savings was seen under most assumptions. The one exception was if all women <50 years with tumors with RS 16-25 elected to receive chemotherapy, initial care costs could increase by $105 million (4% increase).
Conclusion : Personalizing breast cancer treatment based on tumor genetic profiles could result in small cost decreases in the initial 12-months of care. Studies are needed to evaluate the long-term costs and non-monetary benefits of personalized cancer care.
Journal of the National Cancer Institute , résumé, 2018