Abstract PS3-09-03: The Societal Cost Impact of Oncotype-DX® Testing in an Irish Healthcare Setting

Abstract Background The use of genomic testing in patients with node-negative (N0) and 1-3 lymph nodes positive (N1) early-stage breast cancer has had a significant impact on the delivery of chemotherapy in this setting. Our previous studies have identified a reduction in the use of chemotherapy of over 50% in N0 and N1 patients. This has substantial direct economic benefits for the third-party payer, and for the patient in the avoidance of chemotherapy. An area which is often overlooked is the considerable societal costs that are associated with chemotherapy, and there is a paucity of studies that have included an evaluation of these costs for early-stage breast cancer. These costs include lost productivity due to work absence, caregiver productivity losses, and out-of-pocket expenses. The objective of this study was to examine the societal implications of Oncotype DX ® testing in N1 patients at a national level in 5 Irish cancer centres over an 11-year period. Methods A retrospective observational study was undertaken including patients with early-stage ER-positive breast cancer and 1-3 positive lymph nodes who underwent Oncotype DX ® testing between March 2011 to October 2022 across five of Ireland’s cancer centres. A survey of Irish Breast Oncologists provided the assumption that all patients in our study with N1 disease who underwent Oncotype DX ® testing would be recommended adjuvant chemotherapy without testing. Data was collected via electronic records and clinical chart review. The estimated societal costs of chemotherapy were based on UK cost estimates from a report published by the University of East Anglia which used an incidence-based-cost-of-illness model to estimate annual societal costs associated with chemotherapy for early-stage breast cancer. Sterling estimates were converted to euro costs based on the exchange rate of 1 GBP = 1.17025 EUR. Information regarding costing was provided by the National Healthcare Pricing Regulatory Authority and the economic analysis was adjusted for changing costs over the study time-period. Results We identified 828 patients for inclusion in this analysis of societal cost savings associated with the use of Oncotype DX ® testing. The mean age was 58 years (range 22-81). 171 patients (21%) were 50 years at diagnosis, and 657 (79%) were ≥50 years. With the use of Oncotype DX ® testing 58% of patients avoided chemotherapy. As previously published, this resulted in savings of over €6 million in treatment costs, leading to net savings of over €3.3 million euro when the assay cost was deducted. For this societal cost impact analysis, we estimated potential societal costs per patient with early-stage breast cancer undergoing chemotherapy to be €43,628. This figure includes €38,450 and €4,008 due to lost productivity from long-term and short-term work absence respectively, and €1,170 from lost productivity for caregivers. Per patient out-of-pocket expenses totalled €1,287. The total estimated impact of Oncotype DX ® testing among the study cohort on societal costs of chemotherapy treatment was €22,053,500. Conclusion Societal costs are often overlooked as they are not as easily calculated as direct costs, however, it is evident that chemotherapy use carries considerable indirect costs for society. These wider costs alongside a comprehensive consideration of benefits and harms should be incorporated when deciding on a patient’s treatment paradigm. The use of Oncotype DX® testing in N1 patients has led to an estimated societal cost saving of over 22 million euro in across 5 of Ireland’s oncology centres for the period of our study. Citation Format: I. M. Browne, R. A. McLaughlin, C. S. Weadick, S. O'Sullivan, D. K. Hadi, S. J. Millen, M. J. Higgins, J. P. Crown, C. M. Quinn, R. S. Prichard, D. P. McCartan, H. K. Carroll, K. E. Ronan, A. D. Hill, R. M. Connolly, S. A. Noonan, D. O'Mahony, C. O'Hanlon-Brown, B. T. Hennessy, C. M. Kelly, S. O'Reilly, P. G. Morris, J. M. Walshe. The Societal Cost Impact of Oncotype-DX® Testing in an Irish Healthcare Setting abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-09-03.