A €3,000 test could slash by 60 per cent the number of cancer patients that have to undergo chemotherapy and would save the government almost €100,000 a year if it was made freely available to patients, a feasibility study has found.

The Oncotype-DX test predicts how likely breast cancer is to spread within 10 years and gives a score that doctors can use to help determine if a patient will benefit from chemotherapy.

Patients eligible for the test currently must pay for it privately.

The EMCS report, commissioned by the Action for Breast Cancer Foundation, found that 25 patients who underwent chemotherapy between June 2020 and 2021 could have been spared the treatment.

This meant that “each year, a number of patients in Malta are given chemotherapy for nothing”, EMCS director Silvan Mifsud said.

Local data from the Breast Multidisciplinary Team Meetings showed that out of the 362 patients between June 2020 and June 2021, 108 were classified under intermediate risk, meaning they were eligible for Oncotype-DX.

Of these, one was not given chemotherapy, five rejected it, 61 did not take it out of personal choice and the remaining 41 patients (38 per cent) took it.

81% could have been spared chemo

“But realistically, with Oncotype-DX, around 85 per cent of the 108 women with early breast cancer, especially if postmenopausal, could have been spared chemo, meaning the total number requiring the treatment would go down to 16 per year,” the authors calculated.

In this case, Oncotype-DX testing could have taken the number of patients requiring chemo down to 16 from 41, amounting to a 60 per cent reduction.

The project was also considered beneficial in terms of government finances – those patients spared chemotherapy were more likely to continue working or required less time off compared to those receiving the treatment.

This would save the government €97,647 per year, the study calculated, considering outpatient and inpatient care costs, as well as loss of productivity due to absence from work.

The introduction of Oncotype-DX would also spare €2.4 million in government costs that would continue indefinitely, meaning savings would persist over time, the study showed.

It also highlighted that, besides the cost of the chemotherapy itself, there were also “intangible” benefits as the treatment came with downsides that also had an economic price.

These included patients’ struggle with emotional, social and personal problems as well as having to accept changes in their appearance.

But, based on the test results, patients could decide not to have chemotherapy, avoiding unnecessary toxicity and subfertility and resuming normal daily activities earlier.

“Results show that Oncotype-DX will incur additional direct costs. But, given the excessive list of qualitative and quantitative economic benefits, this project far outweighs the total costs incurred, rendering society better-off,” the authors concluded.

Action for Breast Cancer Foundation chairperson Esther Sant said the findings back its argument that the availability of the test would be beneficial from a financial point of view as well as for patients. 

“Patients eligible for this test must spend over €3,000 from their own pockets to have it analysed in the US and get a genomic score that is used to target personalised cancer treatment,” she explained.

“But not everyone can afford this.”

During Breast Cancer Awareness Month in October, Sant had pushed for access to free standard oncogenomics testing and,  at the end of last year, the voluntary organisation contracted EMCS to carry out a detailed economic feasibility study on the clinically validated test.

Turning to Europe

The report also outlined that European countries are now offering the reimbursement of the costs of the Oncotype-DX test from public funds.

The health authorities told Times of Malta last year that they were “evaluating the introduction of oncogenomics testing on the NHS”.

But the health ministry has not responded to questions on the current situation.

Sant said the foundation has been told by Chief Medical Officer Walter Busuttil, on presentation of the report, that Oncotype-DX is seeking approval to operate in Europe and the plan was to await the outcome of this “to consolidate a cheaper price for this much needed test”.

But time is of the essence for the foundation, she said.

The scientific study has been sent to the office of European Parliament president Roberta Metsola and to the Permanent Representation of Malta in the EU.

The latter was asked if any Oncotype-DX test provider was in the process of being given a licence in the EU.

“It is important to know what stage this consideration by the EU has reached and what process to follow until approval,” the foundation told the European institutions.

“We have to work hard and be the voice of vulnerable women without further delay,” it insisted.