New research from University of the Sciences' Mayes College of Healthcare Business and Policy suggests that MammaPrint - a gene expression profiling (GEP) test used to identify whether women with early-stage breast cancer would benefit from chemotherapy - is the more cost-effective and clinically-useful test than the most frequently used GEP in practice in the United States today. The findings have strong implications for health policy makers and health insurance reimbursement decisions, as well as, for health providers and patient outcomes.
To date, Oncotype DX - a 21-gene profile assay - is the most commonly used GEP in clinical practice in the United States. Oncotype DX produces a numerical recurrence score, which places patients in three categories: high risk, intermediate risk and low risk. MammaPrint - a 70-gene profile microarray evaluation used more frequently in Europe - reports results via two categories: high risk or low risk for recurrence.
The research of Amalia M. Issa, PhD, MPH, chair of the Department of Health Policy and Public Health and director of the Program in Personalized Medicine and Targeted Therapeutics, which was published online by Cancer in February 2012, compared Oncotype DX and MammaPrint from a third-party payer's perspective. A 10-year Markov model, which represents changing health states over time, was developed to evaluate the costs and quality-adjusted life years associated with using the two most popular GEP-guided treatment strategies in a hypothetical cohort of 1,000 women with early stage, lymph node-negative, estrogen receptor-positive breast cancer. Outcomes included no recurrence, recurrence, and death. The costs considered included the expenses generated from the administration of the gene test, dispensation of adjuvant chemotherapy and other chemotherapy, as well as cost of treating recurrence, adverse events and end-of-life care.
"Our study is the first to compare two specific gene expression profiling assays head-to-head," explained Dr. Issa. "As personalized genomic medicine continues its progress forward, this study demonstrates the value of doing this type of research for society - to make decisions based on empirical evidence."