Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary

We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the li...

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Bibliographic Details
Published in:The pharmacogenomics journal 2017-06, Vol.17 (3), p.286-300
Main Authors: Hannouf, M B, Winquist, E, Mahmud, S M, Brackstone, M, Sarma, S, Rodrigues, G, Rogan, P, Hoch, J S, Zaric, G S
Format: Article
Language:English
Subjects:
Analysis
Biomarkers, Tumor - genetics
Budgets
Cancer
Cancer patients
Care and treatment
Cost analysis
Cost benefit analysis
Decision Support Techniques
Decision Trees
Development and progression
Diagnosis
Economic aspects
Gene expression
Gene Expression Profiling - economics
Gene Expression Profiling - methods
Gene Expression Regulation, Neoplastic
Genetic aspects
Genetic Predisposition to Disease
Health Care Costs
Humans
Manitoba
Markov Chains
Medical economics
Methods
Models, Economic
Neoplasms, Unknown Primary - economics
Neoplasms, Unknown Primary - genetics
Neoplasms, Unknown Primary - pathology
Neoplasms, Unknown Primary - therapy
Patients
Phenotype
Predictive Value of Tests
Prognosis
Quality-Adjusted Life Years
Registries
Time Factors
Transcriptome
Tumors
Unknown primary cancer
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Summary:We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. The 2000-GEP-based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was $36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test's clinical impact was $4.2 million per year. The 2000-GEP test should be considered for adoption in CUP. Field evaluations of the test are associated with a large societal benefit.
ISSN:1470-269X
1473-1150
DOI:10.1038/tpj.2015.94