Cost-effectiveness analysis of gene-expression-based prognostic tests for patients with early-stage breast cancer in South Korea

Adjuvant chemotherapy (ACT) is a common treatment modality for patients with breast cancer; however, not all patients benefit from this therapy. To identify these patients, gene expression profiling tests, such as Oncotype DX (ODX), have been developed and are widely used. However, performance differences based on ethnicity have been reported for ODX. Therefore, it is necessary to compare the performance and cost-effectiveness of these tests against those developed for Asian patients, such as the GenesWell Breast Cancer Test (BCT). This study evaluated the cost-effectiveness of using ODX, BCT, and no testing to determine the need for ACT in patients with breast cancer by comparing each option. We used decision tree and Markov models over a ten-year horizon to forecast ODX and BCT cost-effectiveness. The results are presented as the incremental cost-effectiveness ratio from the perspective of the payer of Korean National Health Insurance. Uncertainty was assessed using scenario, one-way, and probabilistic sensitivity analyses. Compared to the no-test alternative, BCT gained 0.0977 quality-adjusted life years (QALYs) with savings of US$1,091, while the ODX gained 0.0906 QALYs with savings of US$544, both demonstrating dominance over the no-test. When comparing BCT to ODX, the outcomes were similar, with the BCT strategy achieving a cost savings of US$547 and an additional gain of 0.0071 QALYs. The comparison of gene profiling tests, ODX and BCT, with the no-testing strategy demonstrated comparable levels of QALY improvement and cost savings.