title: Cost-effectiveness of 70-gene MammaPrint signature in node-negative breast cancer.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of 70-gene MammaPrint signature (Agendia Inc, Huntington Beach, CA) vs Adjuvant! Online software (AS) (http://www.adjuvantonline.com) in patients 60 years or younger with early-stage breast cancer.
  
  
  METHODS
  Cost-effectiveness and cost-utility analyses from a US payer perspective.
  
  
  METHODS
  A Markov model with 3 health states was constructed. In the base case model, risk classification 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 Surveillance, Epidemiology and End Results registry was built to examine the external validity of the base case model. The incremental benefits, costs, and cost-effectiveness of treatment guided by 70-gene signature were calculated.
  
  
  RESULTS
  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 approximately $10,000 per life-year or quality-adjusted life-year in the base case model and $700 in the alternative model. The model results were sensitive to estrogen receptor status, the proportion of patients classified as high risk vs low risk, and the overall survival in each risk group.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Quorum Consulting, Inc, 180 Sansome St, 10th Floor, San Francisco, CA 94104, USA. er.chen@quorumconsulting.com
authors.forename: Er
authors.initials: E
authors.lastname: Chen
authors.forename: Kuo Bianchini
authors.initials: KB
authors.lastname: Tong
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D020411:Oligonucleotide Array Sequence Analysis / Q000191:economics*; D011379:Prognosis; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D016019:Survival Analysis; D014481:United States; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents