Adherence to Guidelines in Requesting Oncotype DX in a Publicly Funded Health Care System

Background: Oncotype DX [ODX (Genomic Health, Redwood City, CA, U.S.A.)] is an approved prognostic tool for women with node-negative, hormone receptor–positive, her2-negative breast cancer. Because of cost, optimal use of this test is crucial, especially in a publicly funded health care system. We evaluated adherence with our provincial guidelines for ODX requests, the management of patients with an intermediate recurrence score (RS), and the cost impact of ODX. Methods: This retrospective study included 201 consecutive patients with an ODX request from two university institutions in Quebec between May 2012 and December 2014. Concordance with provincial guidelines was estimated, with its 95% confidence interval (CI). For patients with an intermediate RS, factors influencing the final treatment decision were assessed. The cost impact of ODX was derived from the proportion of patients for whom chemotherapy was not recommended. Results: In 93.0% of patients (95% CI: 89.5% to 96.6%), ODX was ordered according to guidelines. The concordance was similar in both institutions (92.7%; 95% CI: 88.1% to 97.3%; and 93.6%; 95% CI: 88.2% to 99.0%). In 112 (55.7%), 78 (38.8%), and 9 (4.5%) patients, the RS suggested low, intermediate, and high risk respectively. In the intermediate-risk group, most patients (n = 58, 74.4%) did not receive chemotherapy, mainly because of patient preference and the absence of a clear proven benefit. Savings of CA$100,000 for the study period (2.5 years) were estimated to be associated with ODX use. Conclusions: In our experience, the use of ODX was concordant with published recommendations and had a positive cost impact.