{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T15:34:56Z","timestamp":1766504096877},"reference-count":23,"publisher":"Harborside Press, LLC","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,11]]},"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> This study examined whether associations between 21-gene recurrence score (RS) genomic testing and lower costs among patients with early-stage, estrogen receptor\u2013positive breast cancer are observable in real-world data from the Medicare population. <jats:bold>Methods:<\/jats:bold> A retrospective cohort study was conducted using SEER-Medicare data for a nationally representative sample of Medicare beneficiaries diagnosed from 2005 through 2011. The main outcomes were associations between RS testing and overall and chemotherapy-specific costs. The primary analysis was restricted to patients aged 66 to 75 years. <jats:bold>Results:<\/jats:bold> The primary analysis comprised 30,058 patients. Mean costs 1 year after diagnosis were $35,940 [SD, $28,894] overall, $51,127 [33,386] for clinically high-risk disease, $33,225 [$27,711] for intermediate-risk disease, and $26,695 [$19,532] for low-risk disease. Chemotherapy-specific costs followed similar trends. In multivariable analyses, RS testing was associated with significantly lower costs among high-risk patients in terms of both relative costs (cost ratio, 0.88; 99% CI, 0.82\u20130.94) and absolute costs ($6,606; 99% CI, $39,223\u2013$9,290). Higher costs among low-risk and intermediate-risk patients were mainly caused by higher noncancer costs. In sensitivity analyses that included all patients aged \u226566 years (N=64,996), associations between RS testing and costs among high-risk patients were similar but less pronounced because of lower overall use of chemotherapy. <jats:bold>Conclusions:<\/jats:bold> RS testing was associated with lower overall and chemotherapy-related costs in patients with high-risk disease, consistent with lower chemotherapy use among these patients. Higher overall costs for patients with intermediate-risk and low-risk disease were driven largely by non\u2013treatment-related costs.<\/jats:p>","DOI":"10.6004\/jnccn.2018.7097","type":"journal-article","created":{"date-parts":[[2019,3,20]],"date-time":"2019-03-20T16:24:47Z","timestamp":1553099087000},"page":"245-254","source":"Crossref","is-referenced-by-count":10,"title":["Chemotherapy Costs and 21-Gene Recurrence Score Genomic Testing Among Medicare Beneficiaries With Early-Stage Breast Cancer, 2005 to 2011"],"prefix":"10.6004","volume":"17","author":[{"given":"Michaela A.","family":"Dinan","sequence":"first","affiliation":[{"name":"aDuke Clinical Research Institute,"},{"name":"bDuke Cancer Institute, and"},{"name":"cDepartment of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren E.","family":"Wilson","sequence":"additional","affiliation":[{"name":"cDepartment of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shelby D.","family":"Reed","sequence":"additional","affiliation":[{"name":"aDuke Clinical Research Institute,"},{"name":"bDuke Cancer Institute, and"},{"name":"cDepartment of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4047","reference":[{"key":"ref181","first-page":"e195","article-title":"US insurance program\u2019s experience with a multigene assay for early-stage breast cancer","volume":"17","author":"Hornberger","year":"2011","journal-title":"Am J Manag Care"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.breast.2017.11.002","article-title":"Budget impact analysis of gene expression tests to aid therapy decisions for breast cancer patients in Germany","volume":"37","author":"Lux","year":"2018","journal-title":"Breast"},{"key":"ref151","doi-asserted-by":"crossref","first-page":"IV-3","DOI":"10.1097\/00005650-200208001-00002","article-title":"Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population","volume":"40","author":"Warren","year":"2002","journal-title":"Med Care"},{"key":"ref161","first-page":"455","article-title":"Cost-effectiveness of 21-gene assay in node-positive, early-stage breast cancer","volume":"17","author":"Vanderlaan","year":"2011","journal-title":"Am J Manag Care"},{"key":"ref141","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1001\/jamaoncol.2015.2722","article-title":"Association between use of the 21-gene recurrence score assay and receipt of chemotherapy among Medicare beneficiaries with early-stage breast cancer, 2005\u20132009","volume":"1","author":"Dinan","year":"2015","journal-title":"JAMA Oncol"},{"key":"ref191","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1200\/JCO.2011.38.5740","article-title":"Adoption of gene expression profile testing and association with use of chemotherapy among women with breast cancer","volume":"30","author":"Hassett","year":"2012","journal-title":"J Clin Oncol"},{"key":"ref221","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-016-4093-4","article-title":"Algorithms for prediction of the Oncotype DX recurrence score using clinicopathologic data: a review and comparison using an independent dataset","volume":"162","author":"Harowicz","year":"2017","journal-title":"Breast Cancer Res Treat"},{"key":"ref01","doi-asserted-by":"crossref","first-page":"3726","DOI":"10.1200\/JCO.2005.04.7985","article-title":"Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer","volume":"24","author":"Paik","year":"2006","journal-title":"J Clin Oncol"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"e0128880","DOI":"10.1371\/journal.pone.0128880","article-title":"Economic impact of gene expression profiling in patients with early-stage breast cancer in France","volume":"10","author":"Katz","year":"2015","journal-title":"PLoS One"},{"key":"ref11","first-page":"132","article-title":"Gene expression profiling in breast cancer","volume":"5","author":"Arango","year":"2013","journal-title":"Am J Transl Res"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1200\/JCO.2017.76.5941","article-title":"Cost-effectiveness analyses of the 21-gene assay in breast cancer: systematic review and critical appraisal","volume":"36","author":"Wang","year":"2018","journal-title":"J Clin Oncol"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1007\/s10549-013-2559-1","article-title":"Multigene assays and molecular markers in breast cancer: systematic review of health economic analyses","volume":"139","author":"Rouzier","year":"2013","journal-title":"Breast Cancer Res Treat"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"4259","DOI":"10.1200\/JCO.2015.61.9023","article-title":"Adjuvant chemotherapy use and health care costs after introduction of genomic testing in breast cancer","volume":"33","author":"Epstein","year":"2015","journal-title":"J Clin Oncol"},{"key":"ref81","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/gim.2012.119","article-title":"Cost-effectiveness of the 21-gene recurrence score assay in the context of multifactorial decision making to guide chemotherapy for early-stage breast cancer","volume":"15","author":"Reed","year":"2013","journal-title":"Genet Med"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.ejso.2016.12.010","article-title":"Impact of Oncotype DX breast recurrence score testing on adjuvant chemotherapy use in early breast cancer: real world experience in Greater Manchester, UK","volume":"43","author":"Loncaster","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"ref101","first-page":"313","article-title":"Economic analysis of targeting chemotherapy using a 21-gene RT-PCR assay in lymph-node-negative, estrogen-receptor-positive, early-stage breast cancer","volume":"11","author":"Hornberger","year":"2005","journal-title":"Am J Manag Care"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1001\/jamaoncol.2015.43","article-title":"Initial trends in the use of the 21-gene recurrence score assay for patients with breast cancer in the Medicare population, 2005\u20132009","volume":"1","author":"Dinan","year":"2015","journal-title":"JAMA Oncol"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/ajcp\/aqx008","article-title":"Using the modified Magee equation to identify patients unlikely to benefit from the 21-gene recurrence score assay (Oncotype DX assay)","volume":"147","author":"Hou","year":"2017","journal-title":"Am J Clin Pathol"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S1470-2045(09)70314-6","article-title":"Prognostic and predictive value of the 21-gene recurrence score assay in postmenopausal women with node-positive, oestrogen-receptor-positive breast cancer on chemotherapy: a retrospective analysis of a randomised trial","volume":"11","author":"Albain","year":"2010","journal-title":"Lancet Oncol"},{"key":"ref21","article-title":"Practice Guidelines in Version Accessed To view the most recent version of these guidelines go toNCCN org","volume":"17","author":"GradisharWJ","year":"2018","journal-title":"Clinical Oncology Breast Cancer"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s10549-015-3555-4","article-title":"Economic impact of 21-gene recurrence score testing on early-stage breast cancer in Ireland","volume":"153","author":"Smyth","year":"2015","journal-title":"Breast Cancer Res Treat"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1524-4733.2010.00724.x","article-title":"Economic implications of 21-gene breast cancer risk assay from the perspective of an Israeli-managed health-care organization","volume":"13","author":"Klang","year":"2010","journal-title":"Value Health"},{"key":"ref201","doi-asserted-by":"crossref","first-page":"5161","DOI":"10.1002\/cncr.25269","article-title":"Utility of Oncotype DX risk estimates in clinically intermediate risk hormone receptor-positive, HER2-normal, grade II, lymph node-negative breast cancers","volume":"116","author":"Kelly","year":"2010","journal-title":"Cancer"}],"container-title":["Journal of the National Comprehensive Cancer Network"],"original-title":[],"link":[{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/17\/3\/article-p245.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2019,8,4]],"date-time":"2019-08-04T00:46:29Z","timestamp":1564879589000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnccn.org\/view\/journals\/jnccn\/17\/3\/article-p245.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,11]]},"references-count":23,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.6004\/jnccn.2018.7097","relation":{},"ISSN":["1540-1405","1540-1413"],"issn-type":[{"value":"1540-1405","type":"print"},{"value":"1540-1413","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,11]]}}}