1 research outputs found
Compliance to genomic test recommendations to guide adjuvant chemotherapy decisionâmaking in the case of hormone receptorâpositive, human epidermal growth factor receptor 2ânegative breast cancer, in realâlife settings
Abstract Background Genomic tests are a useful tool for adjuvant chemotherapy decisionâmaking in the case of hormone receptorâpositive (HR+), and human epidermal growth factor receptor 2ânegative (HER2â) breast cancer with intermediate prognostic factors. Realâlife data on the use of tests can help identify the target population for testing. Methods French multicentric study (8 centers) including patients, all candidates for adjuvant chemotherapy for HRâpositive, HER2ânegative early breast cancer. We describe the percentage of tests performed outside recommendations, according to the year of testing. We calculated a ratio defined as the number of tests required to avoid chemotherapy for one patient, and according to patient and cancer characteristics. We then performed a costâsaving analysis using medical cost data over a period of 1âyear from diagnosis, calculated from a previous study. Finally, we calculated the threshold of the ratio (number of tests required to avoid chemotherapy for one patient) below which the use of genomic tests was costâsaving. Results A total of 2331 patients underwent a Prosigna test. The ratio (performed test/avoided chemotherapy) was 2.8 [95% CI: 2.7â2.9] in the whole population. In the group following recommendations for test indication, the ratio was 2.3 [95% CI: 2.2â2.4]. In the case of nonâabidance by recommendations, the ratio was 3 [95% CI: 2.8â3.2]. Chemotherapy was avoided in 841 patients (36%) following the results of the Prosigna test. The direct medical costs saved over 1âyear of care were 3,878,798⏠and 1,718,472⏠in the group of patients following test recommendations. We calculated that the ratio (performed test/avoided chemotherapy) needed to be under 6.9 for testing to prove costâsaving. Conclusion The use of genomic testing proved costâsaving in this large multicentric realâlife analysis, even in certain cases when the test was performed outside recommendations