Better Care, Higher VA Cost Savings Tied to 21-Gene RS Test

The use of appropriate treatments for US veterans with breast cancer can be improved through the use of the 21-gene RS test, according to a study was presented at the ISPOR 21st Annual International Meeting (May 21-25, 2016; Washington, DC).

The number of female veterans seeking breast cancer care within the Veterans Administration (VA) heath system is expected to increase. Therefore, there has been strong emphasis on ensuring that care for these veterans is consistent with current treatment guidelines.

Gene expression testing has become standard of care for early stage, estrogen receptor-positive breast cancer patients. In particular, the 21-gene RS test is used to estimate the 10-year risk of breast cancer recurrence and to predict the likelihood of benefiting from chemotherapy. However, both genomic testing and chemotherapy are expensive. The 21-gene test costs $3252 and the current monthly price of chemotherapy ranges from $1000 to $3000.

Researchers sought to determine the clinical impact of using the 21-gene test for patients with breast cancer within the VA health care system. Using 2011-2012 VA Central Cancer Registry data, breast cancer patients eligible for testing were identified. Registry data was merged with test results, and a descriptive analysis was done to summarize patients eligible for testing, treatment decisions, and risk scores.

A total of 571 breast cancer patients eligible for testing were identified. Of those, 98 (17%) were tested. Of those tested, 56% had low risk scores, 34% had medium-risk scores, and 10% had high-risk scores. More medium-risk patients received chemotherapy (52%) compared with high (30%) and low (3%) risk patients. Of those not tested, 37% received chemotherapy.

The findings of the study showed that appropriate use of the 21-gene RS test decreased use of chemotherapy among low-risk patients. This produced significant cost savings for the VA system as well as potential improvements in health outcomes for patients.

The presenters of the study concluded that genomic medicine can improve health outcomes while decreasing costs of care associated with ineffective treatments.

Reference:

Lynch J, Chun DS, Berse B. Clinical Impact of the 21-Gene RS Test Within the Veterans Health Care Administration. Presented at ISPOR 21st Annual International Meeting. May 21-25, 2016; Washington, DC.