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DOI: 10.1055/s-0045-1807970
Cost-effectiveness analysis of the 21 genes platform for guiding treatment decisions in early hormone positive breast cancer: perspective of the Brazilian public health system
Keywords
cost-effectiveness analysis - 21 genes platform - early hormone positive breast cancer - Brazilian public health system - decision-makingIntroduction: The 21-gene platform Oncotype DX helps to select women with early ER-positive breast cancer who won't benefit from adjuvant chemotherapy. This study aimed to assess the cost-effectiveness of using the 21-gene platform for guiding treatment decisions in these patients from the perspective of the Brazilian public health system (SUS). The analysis focused on the costs and outcomes associated with the platform compared to the standard risk factor-based treatment approach.
Methods: A cost-effectiveness analysis was conducted over a 6-month time horizon. The analysis was based on standard values payable by SUS for adjuvant hormone therapy and chemotherapy. We measured effectiveness in quality-adjusted life years (QALYs) and performed sensitivity analyses for different hypothetical costs of the 21-gene platform.
Results: The decision tree model showed that, when considering all patients, using usual clinical risk factors alone was favored over the 21-gene platform for treatment decisions. However, for patients classified as high risk according to clinical factors, the 21-gene platform was cheaper than the usual clinical risk factors up to a platform cost of US$ 294.75. The incremental cost-effectiveness ratio (ICER) for the platform was lower than the 2022 Brazilian gross domestic product per capita (used as the Willingness to Pay) up to a 21-gene platform cost of US$ 1,505.46.
Conclusion: The use of the 21-gene platform can be cost-effective for guiding treatment decisions in early ER-positive breast cancer treated by the SUS for patients at high risk based on clinical factors, if we consider a cost limit of US$ 1,505.46 per test.
Corresponding author: Daniel I G Cubero (e-mail: danielcubero@me.com).
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
06 May 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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Daniel Cubero, Fernando Fonseca, Beatriz Alves, Luiz Vinicius de Alcantaras, Auro del Giglio. Cost-effectiveness analysis of the 21 genes platform for guiding treatment decisions in early hormone positive breast cancer: perspective of the Brazilian public health system. Brazilian Journal of Oncology 2025; 21.
DOI: 10.1055/s-0045-1807970