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Cost-Effectiveness of the 21-Gene Breast Cancer Assay in Mexico

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Abstract

Introduction

The 21-gene breast cancer assay (Oncotype DX®; Genomic Health, Inc.) is a validated diagnostic test that predicts the likelihood of adjuvant chemotherapy benefit and 10-year risk of distant recurrence in patients with hormone-receptor-positive, human epidermal growth receptor 2-negative, early-stage breast cancer. The aim of this analysis was to evaluate the cost-effectiveness of using the assay to inform adjuvant chemotherapy decisions in Mexico.

Methods

A Markov model was developed to make long-term projections of distant recurrence, survival, and direct costs in scenarios using conventional diagnostic procedures or the 21-gene assay to inform adjuvant chemotherapy recommendations. Transition probabilities and risk adjustment were taken from published landmark trials. Costs [2011 Mexican Pesos (MXN)] were estimated from an Instituto Mexicano del Seguro Social perspective. Costs and clinical benefits were discounted at 5% annually.

Results

Following assay testing, approximately 66% of patients previously receiving chemotherapy were recommended to receive hormone therapy only after consideration of assay results. Furthermore, approximately 10% of those previously allocated hormone therapy alone had their recommendation changed to add chemotherapy. This optimized therapy allocation led to improved mean life expectancy by 0.068 years per patient and increased direct costs by MXN 1707 [2011 United States Dollars (USD) 129] per patient versus usual care. This is equated to an incremental cost-effectiveness ratio (ICER) of MXN 25,244 (USD 1914) per life-year gained.

Conclusion

In early-stage breast cancer patients in Mexico, guiding decision making on adjuvant therapy using the 21-gene assay was projected to improve life expectancy in comparison with the current standard of care, with an ICER of MXN 25,244 (USD 1914) per life-year gained, which is within the range generally considered cost-effective.

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Acknowledgments

Sponsorship and article processing charges for this study were funded by Genomic Health, Inc. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Conflict of interest

Juliette Plun-Favreau is an employee of Genomic Health International. William Valentine is an employee of Ossian Health Economics and Communications. Barnaby Hunt is an employee of Ossian Health Economics and Communications. Ossian received funding from Genomic Health International to support the present study. Juan Enrique Bargalló-Rocha, Fernando Lara-Medina, Victor Pérez-Sánchez, Rafael Vázquez-Romo, Cynthia Villarreal-Garza, Hector Martínez-Said, Robin J Shaw-Dulin, and Alejandro Mohar-Betancourt have no conflicts of interest to declare.

Compliance with ethics guidelines

The analysis in this article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Instituto Nacional de Cancerologia, Mexico City, Mexico

    Juan Enrique Bargalló-Rocha, Fernando Lara-Medina, Victor Pérez-Sánchez, Rafael Vázquez-Romo, Cynthia Villarreal-Garza, Hector Martínez-Said, Robin J. Shaw-Dulin & Alejandro Mohar-Betancourt

  2. Ossian Health Economics and Communications, Basel, Switzerland

    Barnaby Hunt & William J. Valentine

  3. Genomic Health International, Geneva, Switzerland

    Juliette Plun-Favreau

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  1. Juan Enrique Bargalló-Rocha
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Correspondence to William J. Valentine.

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Bargalló-Rocha, J.E., Lara-Medina, F., Pérez-Sánchez, V. et al. Cost-Effectiveness of the 21-Gene Breast Cancer Assay in Mexico. Adv Ther 32, 239–253 (2015). https://doi.org/10.1007/s12325-015-0190-8

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  • DOI: https://doi.org/10.1007/s12325-015-0190-8

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