70-gene signature test is cost-effective breast cancer prognostic tool
MedWire News: The 70-gene signature test improves quality-adjusted survival in patients with breast cancer and has the highest probability of being cost-effective when compared with the Sankt Gallen guidelines and the Adjuvant Online Software, according to Dutch researchers.
“The 70-gene signature is a prognostic test used to guide adjuvant treatment decisions in patients with node-negative breast cancer,” explain Wim van Harten (Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam) and colleagues.
The team carried out a comparative analysis of the effects of the 70-gene signature, the Sankt Gallen guidelines, and the Adjuvant Online Software on survival, quality of life adjusted survival, and the cost of treating patients with breast cancer.
The researchers developed a Markov decision model that simulated the 20-year costs and survival outcomes in a hypothetical cohort of node-negative, estrogen receptor-positive breast cancer patients.
They found that the 70-gene strategy was more costly than Adjuvant Online, but less costly than Sankt Gallen. In addition, although there was little difference in survival rates, substantial differences in quality-adjusted survival between the prognostic tools were observed.
Quality-adjusted survival was highest when using the 70-gene signature. Based on costs per quality-adjusted life year (QALY), the 70-gene signature has the highest probability of being cost-effective with a willingness to pay € 4614 (US$ 5710) or more per QALY.
Sankt Gallen showed the highest survival rates compared with the 70-gene signature, but led to substantially increased amounts of adjuvant chemotherapy and hence higher costs, thus demanding a willingness to pay € 29,326 (US$ 36,268) to save 1 life-year.
The researchers note that Sankt Gallen assumed 100% compliance to the prognostic test result and treatment guidelines. This may not be feasible in real life and may therefore affect the cost-effectiveness of the tests, they say.
“According to our analyses, using the 70-gene signature or clinical prognostic tests (Sankt Gallen or Adjuvant Online) in node-negative breast cancer patients results in comparable survival,” conclude van Harten and co-authors in the European Journal of Cancer.
“In terms of quality-adjusted survival, using the 70-gene signature is cost-effective compared to Adjuvant Online and is more effective and less costly than Sankt Gallen,” they add.
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By Laura Dean