Journal Article
. 2019 Jun;112(2).
doi: 10.1093/jnci/djz068.

Expected Monetary Impact of Oncotype DX Score-Concordant Systemic Breast Cancer Therapy Based on the TAILORx Trial

Angela Mariotto 1 Jinani Jayasekerea 2 Valentina Petkov 1 Clyde B Schechter 3 Lindsey Enewold 1 Kathy J Helzlsouer 1 Eric J Feuer 1 Jeanne S Mandelblatt 2 
  • PMID: 31165854
  •     28 References
  •     7 citations


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 aged 50 years and younger 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 posttrial. Sensitivity analyses tested the impact on costs of assumptions about compliance with testing and score-suggested treatment and estimation methods.

Results: Pretrial mean initial costs were $2.816 billion. Posttrial, Oncotype DX testing costs were projected to increase from $115 to $231 million and 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 aged 50 years and younger with tumors with RS 16-25 elected to receive chemotherapy, initial care costs could increase by $105 million (4% increase).

Conclusions: 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 nonmonetary benefits of personalized cancer care.

Effects of Radiotherapy in Early-Stage, Low-Recurrence Risk, Hormone-Sensitive Breast Cancer.
Jinani Jayasekera, Clyde B Schechter, +17 authors, CISNET-BOLD Collaborative Group.
J Natl Cancer Inst, 2018 Sep 22; 110(12). PMID: 30239794    Free PMC article.
A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer.
Soonmyung Paik, Steven Shak, +12 authors, Norman Wolmark.
N Engl J Med, 2004 Dec 14; 351(27). PMID: 15591335
Highly Cited.
Breast-cancer-specific mortality in patients treated based on the 21-gene assay: a SEER population-based study.
Valentina I Petkov, Dave P Miller, +21 authors, Steven Shak.
NPJ Breast Cancer, 2017 Jul 20; 2. PMID: 28721379    Free PMC article.
Highly Cited.
The impact of gene expression profile testing on confidence in chemotherapy decisions and prognostic expectations.
Laura Panattoni, Tracy A Lieu, +5 authors, Scott D Ramsey.
Breast Cancer Res Treat, 2018 Oct 12; 173(2). PMID: 30306429    Free PMC article.
Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population.
Joan L Warren, Carrie N Klabunde, +2 authors, Gerald F Riley.
Med Care, 2002 Aug 21; 40(8 Suppl). PMID: 12187163
Highly Cited.
Communicating genetic and genomic information: health literacy and numeracy considerations.
D H Lea, K A Kaphingst, +2 authors, D W Hadley.
Public Health Genomics, 2010 Apr 22; 14(4-5). PMID: 20407217    Free PMC article.
Cost of care for elderly cancer patients in the United States.
K Robin Yabroff, Elizabeth B Lamont, +4 authors, Martin L Brown.
J Natl Cancer Inst, 2008 May 01; 100(9). PMID: 18445825
Highly Cited.
Differences in initial treatment patterns and outcomes of lung cancer in the elderly.
T J Smith, L Penberthy, +5 authors, S M Retchin.
Lung Cancer, 1995 Dec 01; 13(3). PMID: 8719064
The effect of Oncotype DX recurrence score on treatment recommendations for patients with estrogen receptor-positive early stage breast cancer and correlation with estimation of recurrence risk by breast cancer specialists.
Jennifer E Joh, Nicole N Esposito, +10 authors, Geza Acs.
Oncologist, 2011 Oct 22; 16(11). PMID: 22016474    Free PMC article.
Oncologist and organizational factors associated with variation in breast cancer multigene testing.
Tracy A Lieu, G Thomas Ray, +8 authors, Jeanne S Mandelblatt.
Breast Cancer Res Treat, 2017 Feb 23; 163(1). PMID: 28224383    Free PMC article.
Prospective multicenter study of the impact of the 21-gene recurrence score assay on medical oncologist and patient adjuvant breast cancer treatment selection.
Shelly S Lo, Patricia B Mumby, +8 authors, Kathy S Albain.
J Clin Oncol, 2010 Jan 13; 28(10). PMID: 20065191
Highly Cited.
Survival and treatment for colorectal cancer Medicare patients in two group/staff health maintenance organizations and the fee-for-service setting.
R M Merrill, M L Brown, +4 authors, B H Fireman.
Med Care Res Rev, 1999 Jun 22; 56(2). PMID: 10373723
Projections of the cost of cancer care in the United States: 2010-2020.
Angela B Mariotto, K Robin Yabroff, +2 authors, Martin L Brown.
J Natl Cancer Inst, 2011 Jan 14; 103(2). PMID: 21228314    Free PMC article.
Highly Cited.
Comparison of SEER Treatment Data With Medicare Claims.
Anne-Michelle Noone, Jennifer L Lund, +4 authors, Joan L Warren.
Med Care, 2014 Mar 19; 54(9). PMID: 24638121    Free PMC article.
Highly Cited.
Chemotherapy decisions and patient experience with the recurrence score assay for early-stage breast cancer.
Christopher R Friese, Yun Li, +6 authors, Steven J Katz.
Cancer, 2016 Oct 25; 123(1). PMID: 27775837    Free PMC article.
The effects of oncotype DX recurrence scores on chemotherapy utilization in a multi-institutional breast cancer cohort.
Foluso O Ademuyiwa, Austin Miller, +5 authors, Sunil Badve.
Breast Cancer Res Treat, 2011 Jan 05; 126(3). PMID: 21197567
Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +27 authors, George W Sledge.
N Engl J Med, 2018 Jun 05; 379(2). PMID: 29860917    Free PMC article.
Highly Cited.
Differences in Breast Cancer Survival by Molecular Subtypes in the United States.
Nadia Howlader, Kathleen A Cronin, Allison W Kurian, Rebecca Andridge.
Cancer Epidemiol Biomarkers Prev, 2018 Mar 30; 27(6). PMID: 29593010
Highly Cited.
Recurrence risk perception and quality of life following treatment of breast cancer.
Sarah T Hawley, Nancy K Janz, +8 authors, Steven J Katz.
Breast Cancer Res Treat, 2016 Dec 23; 161(3). PMID: 28004220    Free PMC article.
Prospective Validation of a 21-Gene Expression Assay in Breast Cancer.
Joseph A Sparano, Robert J Gray, +28 authors, George W Sledge.
N Engl J Med, 2015 Sep 29; 373(21). PMID: 26412349    Free PMC article.
Highly Cited.
Psychosocial and Quality of Life in Women Receiving the 21-Gene Recurrence Score Assay: The Impact of Decision Style in Women with Intermediate RS.
Nadiyah Sulayman, Elizabeth Spellman, +4 authors, Suzanne C O'Neill.
J Cancer Epidemiol, 2012 Aug 18; 2012. PMID: 22899924    Free PMC article.
Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline.
Lyndsay N Harris, Nofisat Ismaila, +11 authors, American Society of Clinical Oncology.
J Clin Oncol, 2016 Feb 10; 34(10). PMID: 26858339    Free PMC article.
Highly Cited. Review.
Breast cancer multigene testing trends and impact on chemotherapy use.
G Thomas Ray, Jeanne Mandelblatt, +4 authors, Tracy A Lieu.
Am J Manag Care, 2016 Jun 09; 22(5). PMID: 27266581    Free PMC article.
Medical Care Costs Associated With Cancer in Integrated Delivery Systems.
Matthew P Banegas, K Robin Yabroff, +5 authors, Mark C Hornbrook.
J Natl Compr Canc Netw, 2018 Apr 11; 16(4). PMID: 29632060
Cost Effectiveness of Gene Expression Profile Testing in Community Practice.
Young Chandler, Clyde B Schechter, +8 authors, Jeanne S Mandelblatt.
J Clin Oncol, 2018 Jan 09; 36(6). PMID: 29309250    Free PMC article.
Population-based study of the effect of gene expression profiling on adjuvant chemotherapy use in breast cancer patients under the age of 65 years.
Arnold L Potosky, Suzanne C O'Neill, +8 authors, Marc D Schwartz.
Cancer, 2015 Aug 21; 121(22). PMID: 26291519    Free PMC article.
Costs of cancer care: a view from the centers for Medicare and Medicaid services.
Peter B Bach.
J Clin Oncol, 2007 Jan 11; 25(2). PMID: 17210938
The Oncology Care Model: Perspectives From the Centers for Medicare & Medicaid Services and Participating Oncology Practices in Academia and the Community.
Ron Kline, Kerin Adelson, +5 authors, Ethan Basch.
Am Soc Clin Oncol Educ Book, 2017 Jun 01; 37. PMID: 28561660
Re: Expected Monetary Impact of Oncotype DX Score-Concordant Systemic Breast Cancer Therapy Based on the TAILORx Trial.
Paolo Giorgi Rossi, Eugenio Paci.
J Natl Cancer Inst, 2019 Jun 20; 112(3). PMID: 31214709    Free PMC article.
Updated Overview of the SEER-Medicare Data: Enhanced Content and Applications.
Lindsey Enewold, Helen Parsons, +5 authors, Joan L Warren.
J Natl Cancer Inst Monogr, 2020 May 16; 2020(55). PMID: 32412076    Free PMC article.
Simulation of Chemotherapy Effects in Older Breast Cancer Patients With High Recurrence Scores.
Young Chandler, Jinani C Jayasekera, +3 authors, Jeanne S Mandelblatt.
J Natl Cancer Inst, 2019 Oct 16; 112(6). PMID: 31612208    Free PMC article.
The concordance of treatment decision guided by OncotypeDX and the PREDICT tool in real-world early-stage breast cancer.
Daniel A Goldstein, Chen Mayer, +5 authors, Hadar Goldvaser.
Cancer Med, 2020 May 07; 9(13). PMID: 32372569    Free PMC article.
Comparison of GenesWell BCT Score With Oncotype DX Recurrence Score for Risk Classification in Asian Women With Hormone Receptor-Positive, HER2-Negative Early Breast Cancer.
Mi Jeong Kwon, Jeong Eon Lee, +12 authors, Young Kee Shin.
Front Oncol, 2019 Aug 14; 9. PMID: 31404265    Free PMC article.
Chemotherapy and 21-gene recurrence score testing for older breast cancer patients: A competing-risks analysis.
Ping Zhou, Wen-Wen Zhang, +4 authors, San-Gang Wu.
Breast, 2020 Dec 06; 54. PMID: 33278648    Free PMC article.
Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative.
Paolo Giorgi Rossi, Annette Lebeau, +13 authors, ECIBC Contributor Group.
Br J Cancer, 2021 Feb 19;. PMID: 33597715