Abstract P4-12-11: Cost effectiveness of oncotype Dx for early stage breast cancer under National health insurance
Authors: Kim Y , Han W 
Published: February 2018

Background : Oncotype Dx is being used increasingly for risk stratification to identify for patients with estrogen receptor-positive (ER+), node negative early-stage breast cancer who are most likely to benefit from adjuvant chemotherapy. In Korea, all citizens are covered by national health insurance (NHI), besides patients just pay 5% of hospital bill, if who diagnosed with cancer. NHI can help solve the financial burden for cancer patients.

So the acquisition costs of the Oncotype DX test are sometimes a barrier to its widespread use. This study was conducted for existing cost-effectiveness analyses of Oncotype DX in Korea.

Methods : We analyzed the hospital expenses of patients who diagnosis with LN-negative ER-positive early-stage breast cancer from October 2010 to October 2016 in Seoul National University Hospital. All patients are possible candidates for adjuvant chemotherapy. Among them 273 patients were tested Oncotype Dx. A cost-utility analysis (CUA) was performed.

We analyzed the hospital expenses of chemotherapy by regimens who underwent adjuvant chemotherapy patients, and costs of accompanying adverse event. Each costs of therapy were derived from the hospital administration and expressed by USD. (KRW convert into USD) We also analyzed every patient charges and real expense.

Result :

Of 273 patients, 39(14.3%) were underwent adjuvant chemotherapy. The patients proportion by regimens are FAC(56.4%), AC(10.3%), AC followed by weekly paclitaxel (5.1%), TC(10.3%), AC followed by docetaxel (5.1%), TC and CMF etc. Each patient's hospital expense are roughly 3,000 USD (2,200 – 4,000 USD), it including all costs of laboratory test, computer tomography, chest x-ray, chemoagents and other medications. Of these costs, patients should pay only 5% so it could be around 150 USD (110-200USD).

Disccusion ;

The economic benefits of Oncotype DX are modelled by an overall reduction in chemotherapy usage, thus avoiding associated costs and disutility, and an increase in chemotherapy usage in the high RS group, reducing the risk of recurrence and improving health outcomes. Several studies shows Oncotype DX has been proposed to better estimate baseline risk and response to chemotherapy, to appropriately target chemotherapy to higher risk patients. In the costeffectiveness model, decision making with Oncotype DX in addition to standard decision-making tools is compared with standard decision making without Oncotype DX. From this study, most patient (234 of 273, 85.7%) who are possible candidates for adjuvant chemotherapy avoiding the treatment. A number of studies have looked at the impact of Oncotype DX on clinical decision making. But under the special environment of Korea that most costs who diagnosed with cancer covered by National Insurance health, it relatively expensive than other conturies. So it deserve much consideration that necessity of further studies and reaserches to develop new tools that could be more reasonable in cost in Korea.

Citation Format: Kim Y, Han W. Cost effectiveness of oncotype Dx for early stage breast cancer under National health insurance [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-11.