The Cost-Effectiveness of EndoPredict to Inform Adjuvant Chemotherapy Decisions in Early Breast Cancer

Sebastian Hinde, Chloi Theriou, Shirley May, Lucy Matthews, Amy Arbon, Lesley Fallowfield, David Bloomfield

Research output: Contribution to journalArticlepeer-review


Adjuvant chemotherapy in breast cancer patients post resection has been estimated to reduce mortality rates by up to 30%. However, the heterogeneous nature of the disease and patients implies that not all patients should receive the treatment. Many existing prognostic tools, may not definitively estimate the most effective treatment strategy, resulting in an indeterminate risk classification. In such cases gene expression profiling tests can aid the treatment decision.
This study evaluated the cost-effectiveness of EndoPredict in patients with indeterminate risk classification. A mathematical model was constructed to determine how the change in treatment decisions impacted the long term health of the population, and the future cost implications to the NHS.
EndoPredict was found to lead to 36.9% of patients having a change in treatment decision. As a result its use was found to result in an increase in population health but also in total costs, resulting in an incremental cost-effectiveness ratio of £26,836 per quality adjusted life year. This was subject to significant parametric and structural uncertainty.
While EndoPredict was found to be more expensive overall, its ability to affect a more optimal allocation of chemotherapy, resulted in long term health gains, however, they were insufficient to justify the high cost of EndoPredict.
Original languageEnglish
Pages (from-to)75-83
Number of pages9
JournalHealth Policy and Technology
Issue number1
Early online date24 Dec 2018
Publication statusPublished - 1 Mar 2019

Bibliographical note

© Elsevier, 2018. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.


  • Breast cancer
  • Cost-effectiveness
  • Economic evaluation
  • EndoPredict
  • Gene expression
  • Risk of recurrence

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