Oncotype DX in breast cancer Should we use it in our country

Introduction: Genetic tests are increasingly used in clinical practice. The Oncotype DX genomic test analyses the activity of 21 genes which predict how likely a cancer is to grow and respond to treatment. It is used in early breast cancer, ER positive HER- 2 negative mainly in lymph node negative patients. NCCN and NICE guidelines have included this test in their decision making algorithm. Many studies in western countries have proved the test is cost effective. In this study we have reviewed the situation in our country to see whether it is cost effective in eligible patients. Method: Total cost included cost of drugs, administration, insertion of port, treatment of side effects, blood tests, sick leave, income loss, scans and transport. The information regarding the cost in Iran was collected from different sources including pharmacy, chemotherapy unit, oncologists, patients, social security office and laboratory in governmental and private institutions. Results: We compared the cost of chemotherapy in a group of eligible patients with standard chemotherapy to the control group who had oncotype test and chemotherapy in high risk patients. Comparison was made in governmental and private setting for working and non-working patient.Conclusion: Our study showed that in working female patients the test is cost effective for the country in private and non-private settings. It is not cost effective in non-working patients.