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Observational Study
. 2025 Aug;25(6):e721-e730.
doi: 10.1016/j.clbc.2025.04.011. Epub 2025 Apr 15.

Cost-effectiveness of Prosigna for Adjuvant Treatment Decisions in Early Breast Cancer: Healthcare Sector and Societal Perspectives

Lars Asphaug  1 , Lars A Akslen  2 , Egil S Blix  3 , Beate Boge  4 , Elin F Borgen  5 , Marianne B Brekke  6 , Ragnhild S Falk  7 , Gry A Geitvik  8 , Bjørnar Gilje  9 , Berit Gravdehaug  10 , Anette Heie  11 , Emiel Janssen  12 , Cecilie E Kiserud  13 , Torgunn Kursetgjerde  14 , Anita Langerød  8 , Jon Lømo  5 , Bård Mannsåker  15 , Elin Mortensen  16 , Pernilla Olsson  17 , Alina C Porojnicu  18 , Sunil X Raj  19 , Oluf D Roe  20 , Hege E G Russnes  21 , Helle K Skjerven  22 , Silje Songe-Møller  23 , Magdalena A Vestlid  24 , Hege O Ohnstad  25 , Bjørn Naume  26
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Free article
Observational Study

Cost-effectiveness of Prosigna for Adjuvant Treatment Decisions in Early Breast Cancer: Healthcare Sector and Societal Perspectives

Lars Asphaug et al. Clin Breast Cancer. 2025 Aug.
Free article

Abstract

Background: Gene expression profiling tests such as the Prosigna-assay are used to aid adjuvant treatment decisions in hormone receptor positive (HR+) HER2 negative (HER2-) early breast cancer (EBC). In this evaluation, the cost-effectiveness of Prosigna against immunohistochemical (IHC) markers including Ki-67, was evaluated from the Norwegian healthcare- and societal perspective.

Materials and methods: The treatment decision impact of Prosigna was tested in the prospective, observational EMIT-1 trial. Using individual data collected the first 12 months post-surgery, a decision model was built to project the economic consequences of using the Prosigna compared to IHC-markers for the adjuvant treatment decisions. Health benefits were measured by cost per quality-adjusted life-years (QALYs) and data on income and welfare benefit was obtained from Statistics Norway.

Results: Of 2,178 HR+/HER2- pN0 EBC patients in the EMIT-1 trial, 1,985 had available health economic data and 1,850 had complete income and welfare benefit records. Including all pN0 patients in the Prosigna-test strategy, the test was above the cost-effective threshold (€26,000; incremental cost-per QALY gained (ICER) €255,622) in a healthcare sector perspective. Incorporating also productivity costs, Prosigna was cost-saving (ICER €-435,677). Restricting Prosigna-testing to patients assessed as clear/uncertain chemotherapy candidates, the strategy was cost-effective in both the healthcare and societal perspective (ICER €8884 and €-620170, respectively).

Conclusions: Using the Prosigna-assay for all HR+/HER2- pN0 EBC patients was not cost-effective from a healthcare perspective, but from the societal perspective it was cost-saving. Selecting patients who are clear/uncertain candidates for chemotherapy based on IHC-classification, Prosigna is cost-effective from both perspectives.

Keywords: Adjuvant therapy; Breast cancer; Cost-effectiveness; Decision making; Registry data.

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Conflict of interest statement

Disclosure The authors have declared no conflicts of interest.

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