title: Cost-effectiveness of the 21-gene recurrence score assay in the context of multifactorial decision making to guide chemotherapy for early-stage breast cancer.
abstract: OBJECTIVE
  New evidence is available regarding the utility of the 21-gene recurrence score assay in guiding chemotherapy use for node-negative, estrogen receptor-positive breast cancer. We applied this evidence in a decision-analytic model to re-evaluate the cost-effectiveness of the assay.
  
  
  METHODS
  We cross-classified patients by clinicopathologic characteristics from the Adjuvant! risk index and by recurrence score risk group. For non-recurrence score-guided treatment, we assumed patients receiving hormonal therapy alone had low-risk characteristics and patients receiving chemotherapy and hormonal therapy had higher-risk characteristics. For recurrence score-guided treatment, we assigned chemotherapy probabilities conditional on recurrence score risk group and clinicopathologic characteristics.
  
  
  RESULTS
  An estimated 40.4% of patients in the recurrence score-guided strategy and 47.3% in the non-recurrence score-guided strategy were expected to receive chemotherapy. The incremental gain in quality-adjusted life-years was 0.16 (95% confidence interval, 0.08-0.28) with the recurrence score-guided strategy. Lifetime medical costs to the health system were $2,692 ($1,546-$3,821) higher with the recurrence score-guided strategy, for an incremental cost-effectiveness ratio of $16,677/quality-adjusted life-year ($7,613-$37,219). From a societal perspective, the incremental cost-effectiveness was $10,788/quality-adjusted life-year ($6,840-$30,265).
  
  
  CONCLUSIONS
  The findings provide supportive evidence for the economic value of the 21-gene recurrence score assay in node-negative, estrogen receptor-positive breast cancer.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA. shelby.reed@duke.edu
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Dinan
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003663:Decision Trees; D005260:Female; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D059467:Transcriptome