ArticleClinicoEconomics and outcomes research : CEOR2018
Clinical and economic impact of the 21-gene recurrence score assay in adjuvant therapy decision making in patients with early-stage breast cancer: pooled analysis in 4 Basque Country university hospitals.
Article in ClinicoEconomics and outcomes research : CEOR, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.
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Who cites it
8 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Direct and Indirect Costs of Breast Cancer and Associated Implications: A Systematic Review.Advances in therapy · 2024Pooled it
- Personalised medicine and the decision to withhold chemotherapy in early breast cancer with intermediate risk of recurrence - a systematic review and meta-analysis.European journal of clinical pharmacology · 2020Pooled it
- How is Value Defined in Molecular Testing in Cancer? A Scoping Review.Applied health economics and health policy · 2025Article
- Identification of Patients with Early HR+ HER2- Breast Cancer at High Risk of Recurrence.Geburtshilfe und Frauenheilkunde · 2024Article
- Multigene tests for breast cancer: the physician's perspective.Oncotarget · 2021Article
- Oncotype DX Breast Recurrence ScoreMolecular diagnosis & therapy · 2020Article
- Gene Expression Profiling Tests for Early-Stage Invasive Breast Cancer: A Health Technology Assessment.Ontario health technology assessment series · 2020Article
- Clinical analysis of 21-gene recurrence score test in hormone receptor-positive early-stage breast cancer.Oncology letters · 2019Article
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Authors and funding
10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
purposeThe 21-gene recurrence score (RS) is a genomic test developed as a prognostic and predictive tool to improve the treatment decision making in cases of estrogen receptor-positive and human epidermal growth factor receptor 2-negative early-stage breast cancer. This study examined the clinical and economic impact of its use in 4 Basque Country university hospitals.
methodsTaking into consideration the RS result, we recorded the recommended initial systemic adjuvant therapy (endocrine therapy with or without chemotherapy) according to standard clinicopathologic factors and the final decision about chemotherapy. Then, if the RS was high, chemotherapy was recommended; it was not recommended if the RS was low; for those with an intermediate RS, clinicopathologic factors were considered, and the initial recommendation based on those factors was maintained. In addition, the probability of switching treatment was calculated. Then, we developed an economic evaluation by measuring the treatment's incremental short-term budget impact from both the societal perspective and that of the Basque Health System. Patients' characteristics and chemotherapy use were analyzed using logistic regressions and receiver operating characteristic curves.
resultsWithout an RS, chemotherapy would have been prescribed to 56% of 401 patients, but, with RS use, that percentage decreased to 25. The overall rate of decision change was 35.4%. Test inclusion led to a reduction in chemotherapy costs of €922 per patient in the total population. Although this reduction did not entirely offset the cost of the test, the productivity loss per patient was reduced by €1,977.
conclusionThe 21-gene RS test significantly changed the indication for chemotherapy. As chemotherapy treatments with no benefit were avoided, patients' quality of life was improved. The short-term economic impact was negative for the Basque Health Service, but savings resulted when sick-leave costs were included.
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