Impact of Reimbursement on the Utilisation of Gene Expression Profiles and Chemotherapy Decision-Making in Dutch Breast Cancer Patients: A Population-Based Study.

Abstract

This study examined gene expression profile (GEP) use in relation to reimbursement policies and chemotherapy administration, both for patients with and without GEP indication. Women aged ≥ 18-69 years and diagnosed with early-stage breast cancer between January 2011 and June 2024 were selected from the Netherlands Cancer Registry. GEP use in relation to reimbursement policies and GEP result in relation to chemotherapy administration was analysed using flowcharts and a trend line. For patients with GEP indication, logistic regression analyses were conducted to determine if the reimbursement periods influenced the GEP use, and GEP use was analysed per region in the Netherlands and incidence year using trend lines. In total, 138,765 patients were included. Among 17,525 patients with GEP indication, proportions of patients who received a GEP were higher during retrospective reimbursement (25%) and publicly known reimbursement (37%) compared with no reimbursement (9%) and differed across regions in the Netherlands. Proportions of patients who did not receive chemotherapy were higher for patients who had a low-risk MammaPrint (93%) or Oncotype DX (97%) result compared with patients who had a high-risk MammaPrint (17%) or Oncotype DX (15%) result. Among 13,003 patients with GEP indication who did not receive GEP, 52% did receive chemotherapy. Approximately one-third of patients who met GEP criteria and were eligible for publicly known reimbursement received a GEP. Appropriate follow-up steps and further research seem required to analyse reasons for not ordering a GEP in times of reimbursement, since GEP results help chemotherapy decision-making.