Cost Effectiveness of Gene Expression Profile Testing in Community Practice

Area of Science:

• Oncology
• Health Economics
• Genomics

Background:

• Gene expression profile (GEP) testing aids chemotherapy decisions in early-stage, hormone receptor-positive, HER2-negative breast cancer.
• Onco type DX is a GEP test used to guide treatment for these patients.

Purpose of the Study:

• To evaluate the cost-effectiveness of the Onco type DX GEP test in community practice for eligible patients aged 40-79.
• To compare 25-year societal costs and quality-adjusted life-years (QALYs) of Onco type DX use versus usual care.

Main Methods:

• A simulation model was used to compare Onco type DX testing with usual care.
• Data included test accuracy, chemotherapy effectiveness, patient costs, and survival/recurrence rates from integrated health systems and published sources.
• Sensitivity analyses explored variations in parameters and ideal conditions (100% testing, perfect accuracy).

Main Results:

• Only 24% of eligible patients underwent Onco type DX testing, with higher rates in younger patients and those with stage I disease.
• The cost-effectiveness ratio was $188,125 per QALY in community practice.
• Under ideal conditions (perfect accuracy, 100% adherence), the ratio improved significantly, reaching $39,496 per QALY.

Conclusions:

• GEP testing demonstrates a high cost-effectiveness ratio in real-world community settings.
• Variations in implementation and assumptions can yield cost-effectiveness ratios comparable to established interventions.
• Assessing new technologies requires consideration of both ideal scenarios and practical, real-world implementation challenges.