The cost impact of unselective vs selective MammaPrint testing in early-stage breast cancer in Southern Africa

Ettienne J Myburgh; Josephus J de Jager; Elizabeth Murray; Kathleen A Grant; Maritha J Kotze; Hermanus de Klerk

doi:10.1016/j.breast.2021.05.010

The cost impact of unselective vs selective MammaPrint testing in early-stage breast cancer in Southern Africa

Breast. 2021 Oct:59:87-93. doi: 10.1016/j.breast.2021.05.010. Epub 2021 Jun 1.

Authors

Ettienne J Myburgh¹, Josephus J de Jager², Elizabeth Murray³, Kathleen A Grant⁴, Maritha J Kotze⁵, Hermanus de Klerk²

Affiliations

¹ Panorama Centre for Surgical Oncology, Cape Town, South Africa. Electronic address: ejm@mweb.co.za.
² University of Stellenbosch Business School, Bellville, South Africa.
³ Private Oncology Breast Practice, Constantia, Cape Town, South Africa.
⁴ Department of Biomedical Sciences, Faculty of Health and Wellness, Cape Peninsula University of Technology, Cape Town, South Africa.
⁵ Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, University of Stellenbosch and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.

Abstract

Background: MammaPrint (MP) has been applied in South Africa (SA) for decision-making in early-stage hormone receptor-positive breast cancer since 2006. The cost-impact of MP in SA has not been assessed.

Aim: To assess different MP testing strategies for cost-minimization in early-stage breast carcinoma using a funder perspective.

Methods: Clinico-pathologic information was extracted from a prospectively collected database. Clinical risk stratification was done using Adjuvant Online! (AOL) and the Predict V2.1 algorithm (www.predict.nhs.uk). An unselected MP testing strategy was compared to a selective strategy, testing only clinically high risk (cHigh) patients. Excluding human epidermal growth factor receptor-2 positive tumours, the costs for chemotherapy treatment and MP using funding data were used to evaluate the financial impact of these strategies.

Results: In 583 patients with 601 tumours, 52% were clinically low risk (cLow) (AOL) while the average Predict 10-year survival with chemotherapy was 2.9%. MP correlated strongly with Predict and 318 (60%) patients were MP low risk. Unselective testing allowed omission of chemotherapy in 44 (8.4%) patients but escalated cost by 57.7%. Using a selective testing strategy, only 251 would be tested, de-escalating treatment in 138 (55%) and reducing cost by 19.5%. Considering a Predict value up to 3.2% as cHigh, cost would be up to 7.3% (p = 0.0467) lower with a selective testing strategy.

Conclusion: MP allowed reduction in the use of adjuvant chemotherapy. Unselective use of MP increases overall costs. A selective testing strategy through clinical risk stratification using AOL/Predict results in substantial cost saving.

Keywords: Breast; Cancer; Chemotherapy; Cost; MammaPrint; Microarray; Precision medicine; Predict; Southern africa.

MeSH terms

Africa, Southern
Breast Neoplasms* / drug therapy
Chemotherapy, Adjuvant
Cost-Benefit Analysis
Female
Humans
South Africa