OBJECTIVES: Prognostic tests to identify cancer patients who would not benefit from adjuvant chemotherapy (ACT) are used to save medical costs and improve quality of life. This study aimed to analyze the cost-effectiveness of GenesWell BCT (BCT), a newly introduced prognostic test for adjuvant chemotherapy decision-making in patients with early HR+/HER2-, lymph node 0/1 breast cancer, compared with no testing and the Oncotype DX test (ODX).

METHODS: We conducted our analysis by combining a decision tree model with a Markov model over a 15-year horizon. The analysis was based on data comparing the results of ODX and BCT tests in the same patient cohort. The transition probabilities leading to distant metastasis and death were derived from previous literature and publicly available data. The costs of each disease state were estimated from National Health Insurance claims data. Analysis results are presented as the incremental cost-effectiveness ratio (ICER) from the payer perspective of the Korean National Health Insurance. Uncertainty was assessed through one-way and probabilistic sensitivity analyses.

RESULTS: Compared to the no-test scenario, the BCT saved $578 and gained 0.042 QALYs, while the ODX saved $346 and gained 0.014 QALYs, both demonstrating dominance. When comparing BCT to ODX, the BCT strategy was found to be dominant, achieving a cost savings of $232 and an additional gain of 0.028 QALYs. The number of patients receiving ACT significantly influenced the outcomes when comparing the no-test scenario to ODX, whereas BCT was not affected by any variables in comparisons with either the no-test scenario or ODX.

CONCLUSIONS: A cost-effectiveness evaluation comparing the widely used ODX with BCT revealed that BCT is the dominant option in South Korea.