{"title":"为转移性结直肠癌治疗决策提供信息的基于面板的基因组测试的实际成本效益","authors":"","doi":"10.1016/j.jcpo.2024.100496","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Mutations in <em>KRAS</em> and <em>NRAS</em> are associated with a lack of response to cetuximab and panitumumab, two biologics used for third-line therapy of metastatic colorectal cancer (mCRC). In British Columbia, Canada, eligibility for cetuximab or panitumumab was first based on single-gene <em>KRAS</em> testing. OncoPanel, a multi-gene next-generation sequencing panel with both <em>KRAS</em> and <em>NRAS</em>, was introduced in 2016. Our objective was to estimate the real-world cost-effectiveness of OncoPanel versus to single-gene <em>KRAS</em> testing to inform eligibility for cetuximab or panitumumab in mCRC.</p></div><div><h3>Methods</h3><p>Using population-based administrative health data, we identified a cohort of mCRC patients who had received a <em>KRAS</em> or OncoPanel test, and completed prior chemotherapy in 2010–2019. We matched <em>KRAS</em>- and OncoPanel-tested patients (1:1) using genetic matching to balance baseline covariates. Mean and incremental 3-year costs, survival, and quality-adjusted survival were estimated using inverse-probability-of-censoring weighting and bootstrapping. We conducted scenario-based sensitivity analysis for key costs and assumptions.</p></div><div><h3>Findings</h3><p>All OncoPanel-tested cases (n=371) were matched to a <em>KRAS</em>-tested comparator. In the <em>KRAS</em> and OncoPanel groups, respectively, 55·8 % and 41·2 % of patients were potentially eligible for cetuximab or panitumumab based on mutation status. Incremental cost and effectiveness of OncoPanel were $72 (95 % CI: −6387, 6107), −0·004 life-years (95 % CI: −0·119, 0·113), and −0·011 quality-adjusted life-years (95 % CI: −0·094, 0·075). Reductions in systemic therapy costs were offset by increased costs in other resources. Results were moderately sensitive to time horizon and changes in testing or treatment cost.</p></div><div><h3>Interpretation</h3><p>The use of OncoPanel resulted in more precise targeting of cetuximab and panitumumab, but there was no change in incremental cost or quality-adjusted survival. Understanding the balance of costs achieved in practice can provide insight into the effect of future changes in testing policy, test cost, treatment eligibility, or drug prices in this setting.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538324000304/pdfft?md5=54132aeba8d8f707a75493f9b1a6b33f&pid=1-s2.0-S2213538324000304-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Real-world cost-effectiveness of panel-based genomic testing to inform therapeutic decisions for metastatic colorectal cancer\",\"authors\":\"\",\"doi\":\"10.1016/j.jcpo.2024.100496\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Mutations in <em>KRAS</em> and <em>NRAS</em> are associated with a lack of response to cetuximab and panitumumab, two biologics used for third-line therapy of metastatic colorectal cancer (mCRC). In British Columbia, Canada, eligibility for cetuximab or panitumumab was first based on single-gene <em>KRAS</em> testing. OncoPanel, a multi-gene next-generation sequencing panel with both <em>KRAS</em> and <em>NRAS</em>, was introduced in 2016. Our objective was to estimate the real-world cost-effectiveness of OncoPanel versus to single-gene <em>KRAS</em> testing to inform eligibility for cetuximab or panitumumab in mCRC.</p></div><div><h3>Methods</h3><p>Using population-based administrative health data, we identified a cohort of mCRC patients who had received a <em>KRAS</em> or OncoPanel test, and completed prior chemotherapy in 2010–2019. We matched <em>KRAS</em>- and OncoPanel-tested patients (1:1) using genetic matching to balance baseline covariates. Mean and incremental 3-year costs, survival, and quality-adjusted survival were estimated using inverse-probability-of-censoring weighting and bootstrapping. We conducted scenario-based sensitivity analysis for key costs and assumptions.</p></div><div><h3>Findings</h3><p>All OncoPanel-tested cases (n=371) were matched to a <em>KRAS</em>-tested comparator. In the <em>KRAS</em> and OncoPanel groups, respectively, 55·8 % and 41·2 % of patients were potentially eligible for cetuximab or panitumumab based on mutation status. Incremental cost and effectiveness of OncoPanel were $72 (95 % CI: −6387, 6107), −0·004 life-years (95 % CI: −0·119, 0·113), and −0·011 quality-adjusted life-years (95 % CI: −0·094, 0·075). Reductions in systemic therapy costs were offset by increased costs in other resources. Results were moderately sensitive to time horizon and changes in testing or treatment cost.</p></div><div><h3>Interpretation</h3><p>The use of OncoPanel resulted in more precise targeting of cetuximab and panitumumab, but there was no change in incremental cost or quality-adjusted survival. Understanding the balance of costs achieved in practice can provide insight into the effect of future changes in testing policy, test cost, treatment eligibility, or drug prices in this setting.</p></div>\",\"PeriodicalId\":38212,\"journal\":{\"name\":\"Journal of Cancer Policy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-07-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2213538324000304/pdfft?md5=54132aeba8d8f707a75493f9b1a6b33f&pid=1-s2.0-S2213538324000304-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cancer Policy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213538324000304\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH POLICY & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cancer Policy","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213538324000304","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
Real-world cost-effectiveness of panel-based genomic testing to inform therapeutic decisions for metastatic colorectal cancer
Background
Mutations in KRAS and NRAS are associated with a lack of response to cetuximab and panitumumab, two biologics used for third-line therapy of metastatic colorectal cancer (mCRC). In British Columbia, Canada, eligibility for cetuximab or panitumumab was first based on single-gene KRAS testing. OncoPanel, a multi-gene next-generation sequencing panel with both KRAS and NRAS, was introduced in 2016. Our objective was to estimate the real-world cost-effectiveness of OncoPanel versus to single-gene KRAS testing to inform eligibility for cetuximab or panitumumab in mCRC.
Methods
Using population-based administrative health data, we identified a cohort of mCRC patients who had received a KRAS or OncoPanel test, and completed prior chemotherapy in 2010–2019. We matched KRAS- and OncoPanel-tested patients (1:1) using genetic matching to balance baseline covariates. Mean and incremental 3-year costs, survival, and quality-adjusted survival were estimated using inverse-probability-of-censoring weighting and bootstrapping. We conducted scenario-based sensitivity analysis for key costs and assumptions.
Findings
All OncoPanel-tested cases (n=371) were matched to a KRAS-tested comparator. In the KRAS and OncoPanel groups, respectively, 55·8 % and 41·2 % of patients were potentially eligible for cetuximab or panitumumab based on mutation status. Incremental cost and effectiveness of OncoPanel were $72 (95 % CI: −6387, 6107), −0·004 life-years (95 % CI: −0·119, 0·113), and −0·011 quality-adjusted life-years (95 % CI: −0·094, 0·075). Reductions in systemic therapy costs were offset by increased costs in other resources. Results were moderately sensitive to time horizon and changes in testing or treatment cost.
Interpretation
The use of OncoPanel resulted in more precise targeting of cetuximab and panitumumab, but there was no change in incremental cost or quality-adjusted survival. Understanding the balance of costs achieved in practice can provide insight into the effect of future changes in testing policy, test cost, treatment eligibility, or drug prices in this setting.