title: Genomic profile of breast cancer: cost-effectiveness analysis from the Spanish National Healthcare System perspective.
abstract: BACKGROUND
  Cost-effectiveness analysis of MammaPrint(®) (70-gene signature) in the diagnosis of early breast cancer as a prognosis assay to study the risk of tumor recurrence to administer adjuvant chemotherapy.
  
  
  METHODS
  Markov model assuming a cohort of 60-year-old women with breast cancer. Treatment costs and effects were assessed by comparing the 5-year, 10-year and lifetime risk of recurrence using Adjuvant! Online(®) (online algorithm), 70-gene signature or Oncotype DX(®) (21-gene assay).
  
  
  RESULTS
  70-gene signature showed a life expectancy of 23.55 years at lifetime. Life expectancy was lower for 21-gene assay and online algorithm, with associated quality-adjusted life year gains up to 0.23 and 0.75, respectively, with 70-gene signature. At year 5, the mean cost of 21-gene assay, 70-gene signature and online algorithm was €7100, €6380 and €4580, respectively. 70-gene signature was dominant versus 21-gene assay at any time horizon and would be cost-effective from year 7 versus online algorithm (lifetime: €1457 per quality-adjusted life years gained).
  
  
  CONCLUSIONS
  70-gene signature was a dominant strategy over 21-gene assay and was highly cost-effective versus online algorithm.
authors.affiliation: Medical Oncology Department, Corporació Sanitaria Parc Taulí, Sabadell, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Seguí
authors.forename: Carlos
authors.initials: C
authors.lastname: Crespo
authors.forename: Javier
authors.initials: J
authors.lastname: Cortés
authors.forename: Ana
authors.initials: A
authors.lastname: Lluch
authors.forename: Max
authors.initials: M
authors.lastname: Brosa
authors.forename: Virginia
authors.initials: V
authors.lastname: Becerra
authors.forename: Sebastián Matias
authors.initials: SM
authors.lastname: Chiavenna
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gracia
mesh_terms: D000465:Algorithms; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000235:genetics*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics*; D017024:Chemotherapy, Adjuvant / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics*; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000191:economics* / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D009364:Neoplasm Recurrence, Local; D010641:Phenotype; D057285:Precision Medicine / Q000191:economics*; D011237:Predictive Value of Tests; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
keywords: MammaPrint®; Oncotype DX®; breast cancer; cost–effectiveness; diagnosis; genotyping