Abstract P6-13-08: The DCIS Score - Potential for healthcare savings?

Abstract

Abstract Introduction The Oncotype Dx Recurrence Score for DCIS (DCIS Score) is a 12-gene assay derived from the original Oncotype DX test that evaluates recurrence risk among women with invasive carcinoma of the breast. The DCIS Score provides a local recurrence risk estimate at 10 years following lumpectomy for ductal carcinoma in situ (DCIS). Results can help guide decisions regarding adjuvant radiation (RT). Foregoing RT can be a source of significant healthcare savings. We investigated the actual healthcare dollar savings to-date in our patient population. Methods We evaluated patients in whom the DCIS Score was ordered (x) and calculated total cost of testing. Potential cost of RT was that of IMRT as reimbursed by Medicare for a hypofractionated (16 fraction) course, multiplied by x. Many of our large-breasted patients require IMRT to increase dose homogeneity and to limit dose to normal tissues. We also calculated potential cost with 3D conformal (3D-CRT). Total potential cost was the sum of testing and treatment costs, determined for each modality. The number of patients ultimately treated (y) was also multiplied by these costs. Total actual cost was the sum of test expenses and actual treatment costs. Savings was the difference between the total actual and total potential cost. Results From February, 2012 to May, 2014 the DCIS Score was performed in 38 patients (x= 38). Median age was 66 (40-85). Grade was low in 39%, intermediate in 45%, and high in 16%. 50% had necrosis present, and the median size of DCIS was 0.5cm (0.1 - 3.1cm). The total cost of testing was $4125 * 38 = $156,750. IMRT reimburses at approximately $23, 000 and 3D-CRT at approximately $11,000 per treatment. (Medicare reimbursement rates can vary among states.) The potential total cost of RT ranged from $418,000 - $874, 000; testing brought the total potential costs to $574, 750 - $1,030, 750. Upon receipt of the test results, 12 (y) patients ultimately underwent therapy. IMRT was given in 11 patients and 3D-CRT in 1, for a total treatment cost of $264, 000. Therefore, total actual expenditures were $420, 750. Savings amounted to (574, 750 – 420, 750) = $154, 000 to (1,030, 750– 420, 750) = $ 610, 000. Conclusions In the era of rising healthcare costs, it is imperative to examine instances of possible over-treatment. The DCIS Score has the potential to save not only healthcare dollars, but to spare patients radiation side effects, time lost from work, and transportation expenses. While there are costs associated with the assay, if ordered judiciously, these can be offset by the subsequent savings from eliminating treatment. Citation Format: Rebekah Young, Kimberly Gergelis, Shalom Kalnicki, Jana L Fox. The DCIS Score - Potential for healthcare savings? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-13-08.