A decision impact, decision conflict and economic assessment of routine Oncotype DX testing of 146 women with node-negative or pNImi, ER-positive breast cancer in the UK

• Published in: British journal of cancer Vol. 108; no. 11; pp. 2250 - 2258
• Main Authors: Holt, S, Bertelli, G, Humphreys, I, Valentine, W, Durrani, S, Pudney, D, Rolles, M, Moe, M, Khawaja, S, Sharaiha, Y, Brinkworth, E, Whelan, S, Jones, S, Bennett, H, Phillips, C J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 11-06-2013; Nature Publishing Group
• Subjects: 692/699/67/1059/99; 692/699/67/1347; 692/700/159; 692/700/228/2050/1512; Adult; Aged; Biomedical and Life Sciences; Biomedicine; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Breast Neoplasms - genetics; Breast Neoplasms - metabolism; Cancer Research; Cancer therapies; Chemotherapy; Clinical Study; Cost analysis; Cost-Benefit Analysis; Decision Making; Decision Support Techniques; Drug Resistance; Epidemiology; Female; Gene Expression Profiling - economics; Gene Expression Profiling - methods; Health economics; Hospitals; Humans; Lymphatic Metastasis; Markov Chains; Medical research; Middle Aged; Models, Economic; Molecular Medicine; Mortality; Oncology; Patients; Questionnaires; R&D; Receptors, Estrogen - biosynthesis; Research & development; United Kingdom; Womens health; United Kingdom > UK; Wales; cost-effectiveness; breast cancer; decision impact; cost; chemotherapy
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2013.207

Background:
Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Onco
type
DX testing in the UK.
Methods:
Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subsequently offered Onco
type
DX testing, with changes in chemotherapy decisions recorded. A subset of patients completed questionnaires about their uncertainties regarding chemotherapy decisions pre- and post-testing. All patients were asked to complete a diary of medical interactions over the next 6 months, from which economic data were extracted to model the cost-effectiveness of testing.
Results:
Onco
type
DX testing resulted in changes in chemotherapy decisions in 38 of 142 (26.8%) women, with 26 of 57 (45.6%) spared chemotherapy and 12 of 85 (14.1%) requiring chemotherapy when not initially recommended (9.9% reduction overall). Decision conflict analysis showed that Onco
type
DX testing increased patients’ confidence in treatment decision making. Economic analysis showed that routine Onco
type
DX testing costs £6232 per quality-adjusted life year gained.
Conclusion:
Onco
type
DX decreased chemotherapy use and increased confidence in treatment decision making in patients with ER+ early-stage breast cancer. Based on these findings, Onco
type
DX is cost-effective in the UK setting.