SupplementalTable 1 – Probabilities of Risk Score group assignment and chemotherapy protocol

Parameter / Transition / Point Estimate / Distribution used in PSA / Source
Probability of receiving any chemotherapy / Clinical component
Assay naïve arm
High RS / 0·667 / Gaussian
Med RS / 0·400 / Gaussian
Low RS / 0·290 / Gaussian
Assay informed arm
High RS / 0·944 / Gaussian
Med RS / 0·406 / Gaussian
Low RS / 0·0 / Beta
Probability of receiving given chemotherapy protocol / Clinical component
Assay informed arm
High RS
BRAJFEC / 8·8% / Dirichlet
BRAJDC / 70·1% / Dirichlet
BRAJAC / 17·6% / Dirichlet
BRAJCMFPO / 2·9% / Dirichlet
Med RS
BRAJFEC / 7·7% / Dirichlet
BRAJDC / 77·9% / Dirichlet
BRAJAC / 15·4% / Dirichlet
BRAJCMFPO / 0·0% / Dirichlet
Low RS
BRAJFEC / 0·0% / Beta
BRAJDC / 0·0% / Beta
BRAJAC / 0·0% / Beta
BRAJCMFPO / 0·0% / Beta
Assay naïve arm
High RS
BRAJFEC / 8·3% / Dirichlet
BRAJDC / 79·1% / Dirichlet
BRAJAC / 8·3% / Dirichlet
BRAJCMFPO / 4·2% / Dirichlet
Med RS
BRAJFEC / 16·7% / Dirichlet
BRAJDC / 61·1% / Dirichlet
BRAJAC / 22·2% / Dirichlet
BRAJCMFPO / 0·0% / Dirichlet
Low RS
BRAJFEC / 15·0% / Dirichlet
BRAJDC / 65·0% / Dirichlet
BRAJAC / 20·0% / Dirichlet
BRAJCMFPO / 0·0% / Dirichlet
Probability of developing adverse event to chemotherapy / Hillner 1991
Minor / Chemo -> MnAE / 60% / Gaussian
Major / Chemo -> MjAE / 5% / Gaussian
Fatal / Chemo -> DAE / 0·5% / Gaussian
Probability of dying of cancer / DR -> DCancer / 0·286 / Gaussian / Sekdgel 2007, Younis 2007,
Younis 2008
Probability of dying of non-cancer cause / Multiple -> DOther / 0·0001 / Gaussian / Statistics Canada
Probability of distant recurrence (over 10 years)a / Paik 2006
Tamoxifen only
High RS / RFS1 -> DR1 / 60·5% / Gaussian
Med RS / RFS2 -> DR2 / 90·9% / Gaussian
Low RS / RFS3 -> DR3 / 96·8% / Gaussian
Chemotherapy + Tamoxifen
High RS / RFSC1 -> DRC1 / 88·1% / Gaussian
Med RS / RFSC2 -> DRC2 / 89·1% / Gaussian
Low RS / RFSC3 -> DRC3 / 95·6% / Gaussian
Utility / Tsoi 2010; Hillner 1991; Tengs 2000; Earle 2000
No chemotherapy after surgery / 0·98 / Beta
Chemotherapy, no adverse event / 0·94 / Beta
Chemotherapy, minor adverse event / 0·90 / Beta
Chemotherapy, major adverse event / 0·80 / Beta
Recurrence-free / 0·98 / Beta
Distant recurrence / 0·75 / Gaussian

a – biannual values from published survival curves were used in the model. 10-year point estimates are provided for reference only.

Supplemental Table 2 – Cost inputs of Markov Health State Transition Model

Item / Point Estimate / Source
Cost of Oncotype DX® Assay / $4450
Chemotherapy / BCCA Systemic Therapy Program
BRAJFEC
Additional cost of first appointment / $54·82
Drug cost / cycle / $123·58
Administration cost / cycle / $161·04
Laboratory costs / cycle / $16·72
BRAJDC
Additional cost of first appointment / $44·91
Drug cost / cycle / $1482·79
Administration cost / cycle / $105·71
Laboratory costs / cycle / $16·72
BRAJAC
Additional cost of first appointment / $44·91
Drug cost / cycle / $149·63
Administration cost / cycle / $136·83
Laboratory costs / cycle / $16·08
BRAJCMFPO
Additional cost of first appointment / $54·82
Drug cost / cycle / $79·19
Administration cost / cycle / $221·30
Laboratory costs / cycle / $25·38
Cost of treating major adverse event / $2,484·57 / Tsoi 2010; Younis 2008
Cost of fatal adverse event / $28,680·20 / Tsoi 2010; Ontario Case Costing Initiative
Tamoxifen therapy per year / $173·46 / BCCA Systemic Therapy Program
Following up of recurrence-free patient for 1 year / $448·62 / Tsoi 2010; Will 2000
Treating distant recurrence for 1 year / $20,221·28 / Tsoi 2010; Will 2000
End-of-life medical costs / $21,589·22 / Tsoi 2010; Hornberger 2005

Supplemental References for Supplemental Tables 1 and 2:

Canada S. Mortality, Summary List of Causes. Ottawa: Statistics Canada; 2008.

Earle C, Chapman R, Baker C, Bell C, Stone P, Sandberg E, et al. Systematic overview of cost-utility assessments in oncology. Journal of Clinical Oncology. 18(18): 3302-17, 2000.

Hillner B, Smith T. Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision-analysis model. New England Journal of Medicine. 324: 160-8, 1991.

Initiative OCC. Cost for treatment of sepsis. 2011 [cited 2011 July 18th]; Available from:

Kelly C, Warner E, Tsoi D, Verma S, Pritchard K. Review of the Clinical Studies Using the 21-Gene Assay. The Oncologist. 15: 447-56, 2010.

Paik S, Tang G, Shak S, Kim C, Baker J, Kim W, et al. Gene Expression and Benefit of Chemotherapy in Women With Node-Negative, Estrogen Receptor–Positive Breast Cancer. Journal of Clinical Oncology. 24(23): 3726-34, 2006.

Skedgel C, Rayson D, Dewar R, Younis T. Cost-utility of adjuvant hormone therapies for breast cancer in post-menopausal women: sequential tamoxifen-exemestane and upfront anastrozole. Breast Cancer Research and Treatment. 101(3): 325-33, 2007.

Tengs T, Wallace A. One thousand health-related quality-of-life estimates. Medical Care. 38: 583-637, 2000.

Tsoi D, Inoue M, Kelly C, Verma S, Pritchard K. Cost-Effectiveness Analysis of Recurrence Score-Guided Treatment Using a 21-Gene Assay in Early Breast Cancer. The Oncologist. 15: 457-65, 2010.

Will BP, Berthelot, J-M., Le Petit, C., Tomiak, E.M., Verma, S., Evans, W.K. Estimates of the Lifetime Costs of Breast Cancer Treatment in Canada. European Journal of Cancer. 36: 724-35, 2000.

Younis T, Rayson D, Dewar R, Skedgel C. Modeling for cost-effective-adjuvant aromatase inhibitor strategies for postmenopausal women with breast cancer. Annals of Oncology. 18(2): 293-8, 2007.

Younis T, Rayson D, Sellon M, Skedgel C. Adjuvant chemotherapy for breast cancer: a cost-utility analysis of FEC-D vs. FEC 100. Breast Cancer Research and Treatment. 111(2): 261-7, 2008.