Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer

Abstract

Purpose: We assessed the associations between the 21-gene recurrence score assay (RS) receipt, subsequent chemotherapy use, and medical expenditures among patients with early-stage breast cancer.

Patients and methods: Data from the Pennsylvania Cancer Registry were used to assemble a retrospective cohort of women with early-stage breast cancer from 2007 to 2010 who underwent initial surgical treatment. These data were merged with administrative claims from the 12-month periods before and after diagnosis to identify comorbidities, treatments, and expenditures (n = 7,287). Propensity score-weighted regression models were estimated to identify the effects of RS receipt on chemotherapy use and medical spending in the year after diagnosis.

Results: The associations between RS receipt and outcomes varied markedly by patient age. RS use was associated with lower chemotherapy use among women younger than 55 (19.2% lower; 95% CI, 10.6 to 27.9). RS use was associated with higher chemotherapy use among women 75 to 84 years old (5.7% higher; 95% CI, 0.4 to 11.0). RS receipt was associated with lower adjusted 1-year medical spending among women younger than 55 ($15,333 lower; 95% CI, $2,841 to $27,824) and with higher spending among women who were 75 to 84 years old ($3,489 higher; 95% CI, $857 to $6,122).

Conclusion: RS receipt was associated with reduced use of adjuvant chemotherapy and lower health care spending among women with breast cancer who were younger than 55. Conversely, among women 75 and older, RS testing was associated with a modest increase in chemotherapy use and slightly higher spending. From a population perspective, the impact of RS testing on breast cancer treatment and health care costs is much greater in younger women.

Fig 1.

Number of patients in study cohort, by Pennsylvania county of residence. Pennsylvania county borders are indicated in black. The area of the blue circles indicates the relative numbers of patients in the study cohort from each county. The stars indicate the locations of Pennsylvania’s two largest cities: Pittsburgh (red) and Philadelphia (blue).

Fig 2.

Incremental effect of RS receipt on probability of chemotherapy receipt and incremental effect of RS receipt on total spending. The x-axis indicates patient age. The gold dots and connecting lines represent the difference in probability (0 to 1 scale) of chemotherapy use among RS recipients, with probability change plotted on the right-side y-axis. The blue dots and connecting lines represent the change in total health care costs (2010 $US) among RS recipients, with cost change plotted on the left-side y-axis. The vertical lines indicate 95% CIs for the point estimates. Note that the blue and gold plots are “jittered” slightly along the x-axis to avoid overlap. RS, 21-gene recurrence score assay.