Abstract P5-15-08: Economic Impact of MammaPrint (70-gene signature) in a clinical high risk population: A 10yr Markov model, 6,000-patient retrospective analysis of US claim data
Authors: Blumencranz LE , Høst-Ragab A , Retèl VP , Garlich H , Hwang C , Neijenhuis S , Habibi M , Audeh W 
Published: May 2019

Abstract
Background: MINDACT provided evidence that MammaPrint (MP) can identify patients (pts) with early-stage breast cancer (ESBC) who can safely forego adjuvant chemotherapy (CT). As a result, 46% of clinicopathologically high-risk pts were spared from unnecessary CT toxicities. This study investigates direct and indirect costs for pts and payers during ESBC treatment regimens. The study objective was to quantify average cost of care and savings in a clinical high-risk group where the value of CT is unclear, and MP demonstrates economic and clinical impact. Methods: Risk assessment was based on 6,000 MP tests performed on BCBS members (2016-17). CT claims were retrospectively analyzed utilizing a Blue Cross Blue Shield (BCBS) member database (January-December 2016). Case data was restricted to HR+HER2- ESBC and filtered by authorization for the MP test. All CT claims were including, but not limited to standard of care (SOC) systemic drugs such as cyclophosphamide, docetaxel, paclitaxel and doxorubicin. HCPCS codes were utilized to filter member CT claims. Exclusion criteria: &lt;3 SOC CT claims and previous history of BC. A hybrid decision tree-Markov model was used to estimate cost effectiveness of MP compared to modified Adjuvant Online (mAOL) from a US healthcare payer perspective over a 10yr timeframe. Overall, distant metastasis free survival, and test-utility scores were collected from MINDACT for HR+HER2- pts, and costs derived from the BCBS registry and literature (2016 US dollars). Two scenarios were modelled (1) all women classified as high-risk received CT plus endocrine therapy (ET) while low-risk pts received ET; (2) MP guided treatment was modelled based on the IMPACT study (91% MP Low Risk pts received ET and 83% MP High Risk pts received CT). Outcome measures were quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Results: The majority, 3,540 (59.0%) pts were Low Risk or could safely forgo CT; 2,460 (41.0%) were High Risk. The primary driver for cost differences was whether all services were performed in a physician office ($4.6M) or an outpatient setting ($2M). Including provider settings (inpatient, outpatient, emergency), SOC CT regimens and related services the final average amount authorized was $39,675 per patient. In the first scenario, MP guided treatment was associated with a 0.06 QALY gain (0.05 in scenario 2) compared to mAOL. For cost savings and QALY gain MP was dominant over mAOL in both scenarios. Budget impact analysis estimated cost savings of 88.2- 96.6 million dollars based on BCBS registry data. Given the new cases of BC that are expected to be diagnosed in women in the U.S. annually, pts covered in this population by BCBS (˜30%) and MP eligible cohort (˜36K pts), projected cost savings are estimated at 529.2-644.3 million dollars per annum for the health insurer. Conclusions: CT was associated with significant annual costs from both patient and payer perspectives. As demonstrated in MINDACT, less treatment for some pts is optimal without risk to safety or survival. These findings suggest that MP is cost effective and provides substantial value by sparing pts from toxicities, both therapeutic and financial.
Citation Format: Blumencranz LE, Høst-Ragab A, Retèl VP, Garlich H, Hwang C, Neijenhuis S, Habibi M, Audeh W. Economic Impact of MammaPrint (70-gene signature) in a clinical high risk population: A 10yr Markov model, 6,000-patient retrospective analysis of US claim data [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-08.