A new economic analysis of the OPTIMA randomised trial suggests that a 50-gene test used to guide chemotherapy decisions for some people with early breast cancer could save the NHS about £4 million a year.
The estimate concerns Prosigna, a genomic test that examines activity across genes involved in breast cancer growth. It is designed to indicate the likelihood of the disease spreading and to help clinicians judge whether chemotherapy is likely to add enough benefit alongside hormone treatment. The calculation does not mean that chemotherapy is unnecessary for everyone with breast cancer, and it is not a new NHS funding decision.
What the analysis measured
OPTIMA enrolled 4,429 people aged 40 and over with hormone-sensitive, HER2-negative early breast cancer who would ordinarily have been considered for chemotherapy. Participants had either cancer in up to nine nearby lymph nodes or a tumour measuring at least 30 millimetres. The trial compared standard chemotherapy followed by hormone treatment with a test-directed approach.
In the trial, 67 per cent of participants received a low Prosigna score. For this group, hormone treatment without chemotherapy was judged to be a safe option within the trial’s results. That finding matters because chemotherapy can be valuable in reducing recurrence risk for some patients, but it also brings side effects and requires substantial clinical resources. A genomic result may help distinguish people who are likely to benefit from treatment from those for whom the balance is less clear.
The economic work focused on the first two years after diagnosis. It put the average cost of a standard course of chemotherapy at about £5,500 per patient when drug costs, nursing and day-unit time, medicines used to manage side effects and hospital admissions were included. Across those tested, the use of Prosigna reduced chemotherapy spending by an estimated £3,611 per patient.
A saving estimate, not money already banked
Prosigna itself carries a cost, estimated at about £1,955 per NHS patient at list price. Once that and other treatment-timing costs were taken into account, the analysis calculated a net saving of around £654 for each person tested during the two-year period.
Applying that figure to an estimated 6,159 people a year who fit the trial’s eligibility profile produced a projected annual NHS saving of £4,027,986. Rounded, that is about £4 million. The result is a modelled estimate based on trial data and stated assumptions rather than a record of savings already achieved across the health service.
It also has a defined scope. The calculation looks at treatment costs and use of services over the first two years, so it does not settle the longer-term financial picture. Avoiding chemotherapy may reduce some later costs linked to uncommon but serious treatment effects, but those possible savings were not included in the headline estimate. Equally, the analysis should not be read as a guarantee that the same saving would occur in every hospital or for every eligible patient.
How the test could affect decisions
Chemotherapy is often offered after surgery for early breast cancer when there is concern that microscopic cancer cells could remain or recur elsewhere in the body. Yet cancers that look similar under routine assessment can behave differently. A genomic test uses information from tumour tissue already taken at surgery or biopsy to provide another measure of risk alongside established clinical factors.
For people with a low result in the trial, the test-directed route offered the prospect of avoiding chemotherapy while proceeding with hormone treatment. That could mean avoiding effects such as fatigue, nausea, hair loss, a weakened immune system and the associated risk of infection. For people with higher-risk results, chemotherapy remains part of the treatment pathway considered in the trial.
The findings add an economic dimension to the clinical question. They suggest that, for the defined group studied, more tailored use of chemotherapy could reduce both unnecessary treatment and spending. Decisions about access, individual treatment and any change to routine practice would still require consideration of clinical guidance, local services and each patient’s circumstances.
