New research from Duke University, published in the March 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network, provides evidence that genomic recurrence score (RS) testing using the 21-gene assay is associated with decreased cancer care costs in real-world practice among certain patients with breast cancer who would otherwise receive standard chemotherapy. The RS test helps to predict whether or not an individual woman with non-metastatic breast cancer is likely to benefit from adjuvant chemotherapy. According to these findings, patients identified as clinically high-risk who underwent RS assessment had costs that were roughly $6,600 lower than those who went untested, $3,600 of which was attributable to lower direct chemotherapy costs.
The researchers also found that while RS testing was associated with higher overall costs for patients in the clinically intermediate- and low-risk categories, there were no differences in average chemotherapy costs for these subsets. The increased costs were almost entirely due to higher non-cancer costs.
“This study demonstrates that RS testing provides the greatest reduction in costs among patients who, prior to the test, had the highest likelihood of receiving chemotherapy to begin with,” said Michaela A. Dinan, PhD, Duke University. “In the big picture, the ability for RS testing to reduce either the cost of chemotherapy or total health costs may depend on the general distribution of patients who are clinically considered to be high-, intermediate-, or low-risk. This knowledge should help inform a provider’s decision about when RS testing may be most likely to influence treatment choices.”
Dr. Dinan continued, “Our research indicates that selective use of RS testing, particularly for people with clinically-determined high-risk, non-metastatic breast cancer, provides treatment benefit and cost savings.”
The study was conducted on data from 30,058 Medicare beneficiaries aged 66–75, diagnosed with ER-positive, non-metastatic, invasive breast cancer between 2005 and 2011. 17.5% overall received RS testing as part of their initial workup; within that group, 13.3% were initially clinically classified as low-risk, 69.5% as intermediate-risk, and 17.2% as high-risk. The data came from a Surveillance, Epidemiology, and End Results (SEER) and Medicare linked data set, and costs were calculated by summing Medicare payments from all patient claims and adjusting them to 2013 U.S. dollars.
The team had previously conducted research showing that the RS test leads to a reduction in chemotherapy in women with high-risk disease—suggesting that the test has helped women to opt out of chemotherapy in circumstances where they would have otherwise received it without benefit.
“The NCCN Guidelines recommend strong consideration for the 21-gene assay in patients with ER+, node-negative, pT1b–pT3 tumors, in order to help decide whether or not to add chemotherapy prior to endocrine therapy,” commented Ingrid A. Mayer, MD, MSCI, of Vanderbilt-Ingram Cancer Center, and Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Breast Cancer. “Despite several limitations and confounding biases for this currently published study, its results are consistent with other studies in the U.S. and around the world. However, the clinical high-risk group—which is most affected by RS testing in this study—represents a minority of patients in that age group. Therefore, it is likely that the larger financial impact of RS would be seen in a younger patient population; which is more likely to present with clinically higher-risk cancers. Ultimately, reducing chemotherapy for that group would not only reduce overall treatment costs, but also spare these patients from being absent from the work force, which could have a huge impact on individual household finances.”
The study’s authors also noted that because of the older population in this study, chemotherapy rates were significantly lower than previously reported rates. They agreed that RS testing would likely result in an even more dramatic reduction in costs among younger, higher-risk patient populations with higher baseline rates of chemotherapy use.
Complimentary access to the full study, “Chemotherapy Costs and 21-Gene Recurrence Score Genomic Testing Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005 to 2011” is available until June 10, 2019.
The entire March issue can be found on the redesigned JNCCN.org website, which features simplified site navigation and a better viewing experience across all devices. This edition also includes a guest editorial from NCCN’s Chief Medical Officer, Wui-Jin Koh, MD, on NCCN’s efforts to increase the accessibility of the NCCN Guidelines and other big plans for the future.