OBJECTIVES: Genomic information can help to improve treatment selection in breast cancer. In Sweden the Prosigna and Oncotype DX^® tests are available although their current use in clinical practice is still limited.This study aims to analyse the cost-effectiveness of using gene expression tests in women with early breast cancer by comparing Oncotype DX with Prosigna test or with standard of care (SoC). Furthermore, the expected value of perfect implementation (EVPIM) of these tests was estimated.

METHODS: A decision analytic model was built to estimate the cost-effectiveness and EVPIM of implementing gene expression tests. Model parameters were obtained from published literature and adjusted to Swedish settings. The eligible population consisted of postmenopausal women with ER-positive, HER2-negative invasive breast cancer, without distant metastasis at diagnosis in Sweden 2023. A societal perspective was chosen, including informal care and production loss due to morbidity.

RESULTS: In Sweden year 2023 the eligible population for gene expression testing was 4,849, including of 3,724 women with node negative (N0) disease and 1,125 women with 1-3 lymph node metastases (N1). Estimating cost-effectiveness, the Oncotype DX test is dominating both Prosigna and SoC. The EVPIM for Oncotype DX compared with SoC shows that perfect implementation of the Oncotype DX test results in an increase of quality-adjusted life years (QALYs) of 547 or 585 life years (LYs) per year. The corresponding figures when comparing oncotype DX with the Prosigna test are 1,339 or 1,476 LYs. Finally, the EVPIM cost estimations showed an increase in savings of 53 million Swedish krona (SEK) for Oncotype DX test versus SoC and 411 million SEK for Oncotype DX test versus the Prosigna test.

CONCLUSIONS: Implementing the Oncotype DX test for women with ER-positive and HER2-negative early breast cancer is of great value. Delayed implementation leads to increased costs, reduced quality of life, and life-years lost.