title: Health economic analysis of Breast Cancer Index in patients with ER+, LN- breast cancer.
abstract: OBJECTIVE
  Breast Cancer Index (BCI) is a novel gene expression-based test for patients with estrogen receptor positive (ER+), lymph node negative (LN-) breast cancer that predicts risk of recurrence over 10 years, and also specifically predicts risk of late (≥5 y) recurrences and likelihood of benefit from extended (≥5 y) endocrine therapy. The objective of this study was to evaluate cost utility of BCI from a US third-party payer perspective.
  
  
  METHODS
  Two fact-based economic models were developed to project the cost and effectiveness of BCI in a hypothetical population of patients with ER+, LN- breast cancer compared with standard clinicopathologic diagnostic modalities.
  
  
  METHODS
  Costs associated with adjuvant chemotherapy, toxicity, followup, endocrine therapy, and recurrence were modeled over 10 years. The models examined cost utility compared with standard practice when used at diagnosis and in patients disease-free at 5 years post diagnosis.
  
  
  RESULTS
  Use of BCI was projected to be cost saving in both models. In the newly diagnosed population, net cost savings were $3803 per patient tested. In the 5 years post diagnosis population, BCI was projected to yield a net cost savings of $1803 per patient tested. Sensitivity analyses demonstrated that BCI was cost saving across a wide range of clinically relevant input assumptions.
  
  
  CONCLUSIONS
  BCI was projected to be cost saving when used either at diagnosis or at 5 years post diagnosis. Cost savings are achieved through projected impact on adjuvant chemotherapy use, extended endocrine therapy use, and endocrine therapy compliance. These findings require validation in additional cohorts, including studies of real-world clinical practice.
authors.affiliation: Health Advances, LLC, 9 Riverside Rd, Weston, MA 02493. E-mail: ggustavsen@healthadvances.com.
authors.forename: Gary
authors.initials: G
authors.lastname: Gustavsen
authors.forename: Brock
authors.initials: B
authors.lastname: Schroeder
authors.forename: Patrick
authors.initials: P
authors.lastname: Kennedy
authors.forename: Kristin Ciriello
authors.initials: KC
authors.lastname: Pothier
authors.forename: Mark G
authors.initials: MG
authors.lastname: Erlander
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Schnabel
authors.forename: Haythem
authors.initials: H
authors.lastname: Ali
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000235:genetics* / Q000473:pathology; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics* / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000191:economics / Q000235:genetics; D011237:Predictive Value of Tests; D011960:Receptors, Estrogen / Q000378:metabolism*; D013997:Time Factors
chemical_list: D011960:Receptors, Estrogen