BACKGROUND: Gene expression profiling (GEP) is being used increasingly for risk 
stratification to identify women with lymph node-negative, estrogen 
receptor-positive, early stage breast cancer who are most likely to benefit from 
adjuvant chemotherapy. The authors of this report evaluated the cost 
effectiveness of recurrence score-guided treatment using 2 commercially 
available GEP tests, Oncotype DX (Genomic Health, Redwood City, Calif) and 
MammaPrint (Agendia Inc., Irvine, Calif), from a third-party payer's 
perspective.
METHODS: A 10-year Markov model was developed to compare the costs and 
quality-adjusted life-years (QALYs) of treatment decisions guided by either 
Oncotype DX or MammaPrint in a hypothetical cohort of women with early stage, 
lymph node-negative, estrogen receptor-positive breast cancer who may experience 
recurrence. Outcomes included no recurrence, recurrence, and death. The costs 
considered included gene test costs, the costs of adjuvant chemotherapy and 
other chemotherapy (including premedication, oncology visits, and monitoring for 
adverse events), the cost of treating recurrence, costs associated with the 
treatment of adverse events, and end-of-life care costs.
RESULTS: The model demonstrated that the patients who received the Oncotype DX 
test to guide treatment spent $27,882 (in US dollars) and gained 7.364 QALYs, 
whereas patients who received the MammaPrint test to guide treatment spent 
$21,598 and gained 7.461 QALYs. Sensitivity analyses demonstrated that the 
results were robust to changes in all parameters.
CONCLUSIONS: The model suggested that MammaPrint is a more cost-effective GEP 
test compared with Oncotype DX at a threshold willingness-to-pay of $50,000 per 
QALY. Because Oncotype DX is the most frequently used GEP in clinical practice 
in the United States, the authors concluded that the current findings have 
implications for health policy, particularly health insurance reimbursement 
decisions.