Breast Cancer Research and Treatment

, Volume 133, Issue 3, pp 1115–1123 | Cite as

Cost-utility of the 21-gene recurrence score assay in node-negative and node-positive breast cancer

  • Nathan W. D. Lamond
  • Chris Skedgel
  • Daniel Rayson
  • Lynn Lethbridge
  • Tallal Younis


The 21-gene recurrence score (Oncotype DX®: RS) appears to augment clinico-pathologic prognostication and is predictive of adjuvant chemotherapy benefit in node-negative (N−) and node-positive (N+), endocrine-sensitive breast cancer. RS is a costly assay that is associated with good ‘value for money’ in N− disease, while economic evaluations in N+ disease based on most recent data have not been conducted. We examined the cost-utility (CU) of a RS-guided adjuvant strategy, compared to current practice without RS in N− and N+, endocrine-sensitive, breast cancer from a Canadian health care system perspective. A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALYs) over a 25-year horizon. Patient outcomes with and without chemotherapy in RS-untested cohorts and in those with low, intermediate and high RS were examined based on the reported prognostic and predictive impact of RS in N− and N+ disease. Chemotherapy utilization (current vs. RS-guided), unit costs and utilities were derived from a Nova Scotia Canadian population-based cohort, local unit costs and the literature. Costs and outcomes were discounted at 3% annually, and costs were reported in 2011 Canadian dollars ($). Probabilistic and one-way sensitivity analyses were conducted for key model parameters. Compared to a non-RS-guided strategy, RS-guided adjuvant therapy was associated with $2,585 and $864 incremental costs, 0.27 and 0.06 QALY gains, and resultant CUs of $9,591 and $14,844 per QALY gained for N− and N+ disease, respectively. CU estimates were robust to key model parameters, and were most sensitive to chemo utilization proportions. RS-guided adjuvant therapy appears to be a cost-effective strategy in both N− and N+, endocrine-sensitive breast cancer with resultant CU ratios well below commonly quoted thresholds.


Breast cancer 21-RS assay Cost-utility analysis Economic evaluation Adjuvant chemotherapy 



This study has been supported by the Canadian Breast Cancer Foundation—Atlantic Chapter. The authors would like to thank Mrs. Marlene Sellon for her help with drug costing.

Conflict of interest

The authors have no conflict of interest to declare. The CU study was not supported by pharmaceutical companies or Genomic Health, Inc.

Supplementary material

10549_2012_1989_MOESM1_ESM.tif (161 kb)
Online Resource Figure 1: Incremental Costs and QALYs in Node-negative and node-positive Breast Cancer. The Y axis shows the incremental costs (in $) associated with RS testing, while the X axis shows the incremental QALYs gained. Abbreviations – RS: recurrence score. QALY: quality-adjusted life year (TIFF 161 kb)
10549_2012_1989_MOESM2_ESM.doc (54 kb)
Supplementary material 2 (DOC 54 kb)
10549_2012_1989_MOESM3_ESM.doc (26 kb)
Supplementary material 3 (DOC 26 kb)


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Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Nathan W. D. Lamond
    • 1
  • Chris Skedgel
    • 2
  • Daniel Rayson
    • 1
    • 2
  • Lynn Lethbridge
    • 3
  • Tallal Younis
    • 1
    • 2
  1. 1.Department of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Atlantic Clinical Cancer Research Unit (ACCRU) at the Queen Elizabeth II Health Sciences CentreHalifaxCanada
  3. 3.Department of Community Health and EpidemiologyDalhousie UniversityHalifaxCanada

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