In September 2012 the Basque Health Service decided to reimburse the Oncotype DX test as an adjunt to decision making for women with early-stage (pT1-T2), hormone receptor (HR) + / HER2 negative and node negative (pN0) or pN1mi breast cancer. Our objective was to carry out a budget impact analysis (BIA) assessing the short term cost for the Basque Health Service of introducing the Oncotype DX® test into clinical practice in the Basque country.
The analysis was carried out in 4 centers of the Basque Country from a total of 7 centers performing the test at the Basque Health Service. Treatment decisions about endocrine therapy +/- chemotherapy prescription were recorded before and after the Oncotype DX test results were delivered to the physicians. The study was conducted in the perspective of the Basque Health service and therefore only captured direct medical costs. Total costs of chemotherapy (i.e. chemotherapy drugs, concomitant medications such as G-CSF, administration cost, hospitalization due to adverse events and follow-up medical visits) were calculated by multiplying resources consumption by their unit costs. Data on resources used were obtained from the medical oncology units participating in the study belonging to Araba University Hospital, Basurto University Hospital, Donostia University Hospital and Onkologikoa. Unit costs, including drug prices were collected from the Basque Health Service accounting system. The unit cost of the Oncotype DX® test was 2,620€.
401 patients were included in the study. Treatment decisions were changed for 142 patients (35.41%) out of which shift from chemo-endocrine to endocrine therapy only, occurred in 133 cases. Using the Oncotype DX® test allowed to save 377,949€ in chemotherapy costs, thus rendering 942€ per patient tested.
The cost of the Oncotype DX® test was partially compensated by the chemotherapy cost savings. It is important to note that this analysis is limited as it only focuses on short term costs. Indeed, it does not incorporate long term costs nor does it capture the clinical benefits associated with the use of the Oncotype DX test.
Clinical trial identification
Legal entity responsible for the study
All authors have declared no conflicts of interest.