PCN96 - Economic Consequences of the Adaption of the 21 Gene Reverse Transcriptase-Polymerase Chain Reaction RT-PCR Assay from The Greek Third Payer Perspective

Abstract

The evaluation of the economic consequences of 21-gene RT-PCR assay OncotypeDX introduction to the reimbursement scheme of National Organization for Health Provision-EOPYY. A decision tree was developed concerning two treatment scenarios for the year 2013: a) chemotherapy admission according the common treatment practice without the application of the test vs b) chemotherapy admission depending on the results of the test. The sub-group of breast cancer patients appropriate for applying the test was determined according international guidelines and included early stage breast cancer women with hormone receptor positive and lumph node negative age ≤65 years. Cancer incidence was derived from ELSTAT and OECD base, while some assumptions were made concerning the age structure and disease stage of the population. The percentages of women assessed as high risk (score>31) for recurrence were obtained from EOPYY data for 2013. The estimated cost for OncotypeDX test was set according the EOPYY reimbursement price (€2,848 for 2013). Cost of chemotherapy and other cost items (eg laboratory tests) were based on official reimbursed prices. Out of 4,934 newly diagnosed breast cancer women, 27.5% (1,357) were appropriate for the test application. Only 35% of the women undertaken the oncotype test (N=1,357) were found as high risk for recurrence (N=475). The average total cost of chemotherapy treatment was estimated to €8,271 from which more than 80% refer to pharmaceuticals. The total treatment cost for women who didn’t undertake the test reached to €10.9 mil., while the relevant cost for women who undertook the test was estimated to €8 mil. The introduction of Oncotype DX® to the Greek health care system had as a result annual cost savings of almost €3 million and avoidance of unnecessary chemotherapy treatment (and associated complications) to more than 880 women.