Cost and Clinical Benefits Associated with Oncotype DX® Test in Patients with Early-Stage HR+/HER2- Node-Negative Breast Cancer in the Netherlands

Table 1

The list of inputs/calculated inputs used in the cost-consequence model and their sources.

Parameter	Subparameter	Value	Source
Patient population	Approximate number of patients in the Netherlands diagnosed with invasive breast cancer annually	15,000	Incidence Breast Cancer IKNL [23]
	Proportion of patients with disease stage I or II	73%	IKNL and Oncotype [23, 24]
	Proportion of patients with HR+/HER2 early-stage invasive breast cancer	74.7%	NBCA [25]
	Proportion of patients with N0 early-stage invasive breast cancer	82.8%	NBCA [25]
	Proportion of patients who would be considered eligible for genomic testing	30%	ZIN viewpoint Oncotype [26]
	Mean body surface area (m^2)	1.75
Distribution of risk score result	Oncotype DX test—RS 26 to 100	27%	Sparano [12]
	Oncotype DX test—RS 11 to 25	60%	Sparano [12]
	Oncotype DX test—RS 0 to 10	13%	Sparano [12]
	MammaPrint—low risk	46%	Cardoso [18]
	MammaPrint—high risk	54%	Cardoso [18]
	No genomic test—low risk	0%	Dutch clinical expert
	No genomic test—high risk	100%	Dutch clinical expert, only patients that are eligible for chemotherapy are provided a genomic test as part of the Dutch clinical setting
General	Average number of supportive G-CSF rounds given per treatment regimen	4	Dutch clinical expert
Distribution of chemotherapy regiments	3xFEC100+3xT	50%	Dutch clinical expert; Retèl [30]
	4x(dd)AC+12xP (wkl)	25%
	4x(dd)AC+4xT	25%
Total chemotherapy regimen acquisition costs	3xFEC100+3xT	€5723.67	-Index [27]
	4x(dd)AC+12xP (wkl)	€6966.36
	4x(dd)AC+4xT	€5964.17
Chemotherapy administration costs per regimen	3xFEC100+3xT	€5428.13	DRG: code 020107015 [28]; DRG tariff table: code 070201 [31] [29]
	4x(dd)AC+12xP (wkl)	€14,407.52
	4x(dd)AC+4xT	€7230.01
Port implantation	Occurs in 10% of patients	€105.34	Dutch DRG tariff table
Short-term AE costs	Total grade I/II	€444.31	Bouwmans [32], Wehler [33], ZIN assessment palbociclib (Ibrance®), ZIN assessment evrolimus (Afinitor) [34, 35]
	Total grade III	€1991.77
	Total grade IV	€287.15
Long-term AE costs	Acute myeloid leukemia	€667.31	Wolff [36], Leunis [37], ZIN reassessment trastuzumab (Herceptin), Boekel [38]
	Chronic heart failure	€359.22
Productivity losses	% gross labor participation (15-65 years)	74%	Dutch costing manual [29]
	Average worked hours per person per week corrected for labor rate	20
	Proportion of early-stage breast cancer patients below retirement age	56.45%
	Productivity cost per hour, women	€33.75
	Productivity costs per day, corrected for proportion above retirement age	€54.41
	Friction period (days)	111
	Total productivity loss per person	€6054.91
GPT costs	Oncotype DX test	€4487.02	Maximum tariff for Oncotype DX test and MammaPrint. NZA: ZA-code 050531 for Oncotype DX test and NZA: ZA code 050530 for MammaPrint, 2021
	MammaPrint	€3773.48
Cost of recurrence	Mean cost per patient for recurrence	€47,211.28	Thomas [39]
10-year probability of distant recurrence with chemotherapy	Oncotype DX test RS 0 to 10	0.020	Sparano [12], Cardoso [40], Harnan [41] Dutch clinical expert
	Oncotype DX test RS 11 to 25	0.061
	Oncotype DX test RS 26 to 100	0.120
	MammaPrint low	0.101
	MammaPrint high	0.084
	No genomic test low	Costs assumed to be similar to Oncotype DX test
	No genomic test high
Cost of hospitalization	—	€605.32	Dutch costing manual [29]

Abbreviations: FEC = fluorouracil-epirubicin-cyclophosphamide; T = docetaxel; (dd)AC = doxorubicin-cyclophosphamide; P = paclitaxel; G-CSF = granulocyte colony-stimulating factor; AEs = adverse events; RS = recurrence score.