Fifteen years after the OPTIMA trial in early breast cancer was conceived, its health economic results were presented at the ESMO Congress 2026 in Madrid on 25 October (LBA86) by our group lead Peter Hall. Pete began working on the design of OPTIMA in 2010 as part of his PhD at the University of Leeds, the PhD took a novel Bayesian approach using Value of Information Analysis to help design the trial, including on the choice of which test (Hall et al., JNCI 2012). Over a two year time horizon, genomic test-directed treatment cost the NHS £654 less per patient than standard chemotherapy (95% CI −£1,525 to £218) and gained 0.049 quality-adjusted life years (QALYs) (95% CI 0.021 to 0.076), so it dominated standard care.
What did the OPTIMA clinical results show?
Professor Rob Stein (UCL) presented the co-primary clinical endpoint at the ASCO Annual Meeting on 30 May 2026 (J Clin Oncol 2026;44(16_suppl):500). Test-directed treatment was non-inferior to chemotherapy for all for five-year invasive breast cancer-free survival (91.8% compared with 90.3%; HR 1.03, 90% CI 0.85–1.25), and 68% of patients in the test-directed arm avoided chemotherapy. A recording of Professor Stein’s results presentation is available from the Scottish Breast Studies Group webinars page. The results are summarised by The ASCO Post and the Institute of Genetics and Cancer, and the full manuscript is on the Lancet preprint server (SSRN 7551826).
What does the OPTIMA economic analysis add?
The hospital cost of standard adjuvant chemotherapy in the NHS was measured directly from trial case report forms in 1,697 UK patients, at £5,540 per patient. Delivery accounted for £3,621, supportive medicines for £1,207 and chemotherapy-related admissions for £588, with drug acquisition contributing only £124. Test-directed treatment saved £3,611 per patient in chemotherapy costs, partly offset by earlier ovarian suppression (£487), abemaciclib (£382) and radiotherapy (£137).
Threshold analysis set the price of the test against these savings. Prosigna-directed treatment remains cost-saving up to a test list price of about £2,550 per patient, compared with a base-case list price of £1,896, and cost-effective up to £3,520 at £20,000 per QALY and £4,250 at £35,000 per QALY.
How can NHS services use these results?
Local business cases for adopting Prosigna in the OPTIMA-eligible population, directly measured chemotherapy savings and day-unit activity from the trial. Test-directed treatment reduced the proportion of UK patients assigned chemotherapy from by 68% (546 of 1,728), which cut chemotherapy delivery costs, covering nurse and day-unit time, by £2,370 per patient tested and chemotherapy-related admissions by £367. Across the roughly 6,200 OPTIMA-eligible patients given chemotherapy in the UK each year, about 4,200 would avoid it, freeing chemotherapy unit capacity, and a net saving of £654 per patient tested comes to about £4 million a year (Institute of Genetics and Cancer, 26 October 2026). Current approvals are narrower, covering post-menopausal patients with up to three involved nodes in England, Wales and Northern Ireland and node-negative patients only in Scotland (UCL News). The two-year horizon excludes most recurrences, and a lifetime model will follow, which will be essential to fully understand cost-effectiveness.
Where can I find the presentations and coverage?
- Lunch with OPTIMA: trial results, Professor Rob Stein (Scottish Breast Studies Group)
- Institute of Genetics and Cancer news, 26 October 2026
- UCL press release, 25 October 2026
- The Sunday Times
- Institute of Genetics and Cancer news, 29 May 2026
- OPTIMA clinical manuscript, Lancet preprint
- Stein et al., ASCO 2026 abstract 500
- Hall et al., JNCI 2012