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

Genomic analysis of breast tumours has promised more individualised treatment and have been shown to reduce uncertainty when making clinical decisions, but cost and accessibility have remained a barrier for many patients worldwide

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

2021

Scholarcy highlights

  • Genomic analysis of breast tumours has promised more individualised treatment and have been shown to reduce uncertainty when making clinical decisions, but cost and accessibility have remained a barrier for many patients worldwide
  • MammaPrint is currently indicated for oestrogen receptor/progesterone receptor positive, human epidermal growth factor receptor 2 negative tumours of up to 5 cm with up to 3 nodes involved 29; it was initially applied to all subtypes of breast cancer and some HER2 positive or ER/PR negative patients have been tested at the discretion of the treating oncologist
  • 2) Selective testing where only tumours considered clinically high risk based on Adjuvant Online! or Predict is submitted to MP testing, omitting chemotherapy in MPLow cases
  • At a Predict threshold value of 3.2%, 59 fewer patients would require chemotherapy with a total cost saving of MammaPrint remains an expensive assay in South Africa and as price pressures mount in healthcare, the pragmatic implementation of cost saving strategies become increasingly relevant
  • MP remains a valuable assay in reducing the requirement for cytotoxic chemotherapy in early-stage breast cancer
  • Using a selective testing strategy, only 251 would be tested, de-escalating treatment in 138 and reducing cost by 19.5%
  • In accordance with international guidelines 29, we would strongly advise that referral for MP testing be limited to patients deemed clinical high risk with the intention of identifying those where chemotherapy may be omitted
  • JJ de Jager performed data processing, conceptualisation of the Breakeven Cost Ratio metric, compilation of the manuscript and obtained ethics approval for the cost benefit analysis

Need more features? Save interactive summary cards to your Scholarcy Library.