Oncotype DX in clinical practice: impact on treatment decisions and healthcare system economy

Objective: The aim of this study is to assess the impact of Oncotype DX on treatment decisions and healthcare economy. Methods: Data were retrospectively collected from Fondazione Policlinico Universitario Campus Bio-Medico of Rome. 313 female patients with HR-positive, HER2-negative breast cancer underwent Oncotype DX between August 2020 and January 2024. Recurrence score, recurrence risk and chemotherapy benefit were collected from Oncotype DX report. Clinical and pathological data were collected. To objectify the oncological prescription based on clinicopathological variables, we used PREDICT 2.2 algorithm. Reimbursements, hospital accesses and number of health services in one-year follow-up were also collected. Results: Oncotype DX did not indicate chemotherapy in 223/313 (71.2%) patients. In the PREDICT 2.2 scenario, 147/313 (47%) patients were not indicated chemotherapy. Thus, genomic test approach led to a decrease of 24.2% in chemotherapy prescription. Patients receiving chemotherapy had 21 (+91.3%) more hospital accesses, 115 (+101.8%) more health services and a reimbursement of €2811 (+31.5%) higher than patients not receiving chemotherapy (median values). Conclusions: Oncotype DX results in lower rates of chemotherapy prescription and in possible healthcare cost savings.