To evaluate the cost-effectiveness of 70-gene MammaPrint signature (Agendia Inc, Huntington Beach, CA) vs Adjuvant! Online soft ware (AS) (http://www.adjuvantonline.com) in patients 60 years or younger with early-stage breast cancer.
Cost-effectiveness and cost-utility analyses from a US payer perspective.
A Markov model with 3 health states was constructed. In the base case model, risk classiἀcation and patient outcomes were based on a 70-gene signature validation study. Efficacy of chemotherapy was derived from a published meta-analysis of clinical trials. An alternative model using data from AS and from the Surveil-lance, Epidemiology and End Results registry was built to examine the external validity of the base case model. The incremental beneἀts, costs, and cost-effectiveness of treatment guided by 70-gene signature were calculated.
In the base case model, 70-gene signature reclassified 29% of patients and spared 10% of patients from chemotherapy. Compared with the AS strategy, the 70-gene signature strategy was associated with $1440 higher total cost per patient and with 0.14 additional life-year or 0.15 additional quality-adjusted life-year. Overall, the incremental cost-effectiveness ratios were ap-proximately $10,000 per life-year or quality-ad-justed life-year in the base case model and $700 in the alternative model. The model results were sensitive to estrogen receptor status, the propor-tion of patients classiἀed as high risk vs low risk, and the overall survival in each risk group.
A 70-gene signature is likely to be a cost-effective strategy to guide adjuvant chemotherapy treatment in younger patients with early-stage breast cancer.