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

IF 2 Q3 HEALTH POLICY & SERVICES Journal of Cancer Policy Pub Date : 2024-07-18 DOI:10.1016/j.jcpo.2024.100496
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引用次数: 0

摘要

背景KRAS和NRAS突变与对西妥昔单抗和帕尼单抗缺乏反应有关,这两种生物制剂被用于转移性结直肠癌(mCRC)的三线治疗。在加拿大不列颠哥伦比亚省,西妥昔单抗或帕尼单抗的治疗资格首先基于单基因 KRAS 检测。2016年推出了同时检测KRAS和NRAS的多基因新一代测序面板OncoPanel。我们的目标是估算OncoPanel与单基因KRAS检测的实际成本效益,以告知mCRC患者西妥昔单抗或帕尼单抗的资格。方法利用基于人群的行政健康数据,我们确定了一组接受过KRAS或OncoPanel检测,并在2010-2019年完成了既往化疗的mCRC患者。我们使用基因匹配法对接受 KRAS 和 OncoPanel 检测的患者进行了配对(1:1),以平衡基线协变量。我们使用反概率加权法和引导法估算了平均和增量 3 年成本、生存率和质量调整后生存率。我们对关键成本和假设进行了基于情景的敏感性分析。研究结果所有经过 OncoPanel 检测的病例(n=371)都与经过 KRAS 检测的比较者相匹配。在 KRAS 组和 OncoPanel 组中,根据突变状态,分别有 55-8% 和 41-2% 的患者可能符合西妥昔单抗或帕尼单抗的治疗条件。OncoPanel的增量成本和有效性分别为72美元(95 % CI:-6387,6107)、-0-004生命年(95 % CI:-0-119,0-113)和-0-011质量调整生命年(95 % CI:-0-094,0-075)。系统治疗成本的减少被其他资源成本的增加所抵消。结果对时间跨度和检测或治疗成本的变化适度敏感。解释:OncoPanel的使用使西妥昔单抗和帕尼单抗的靶向性更精确,但增量成本或质量调整生存期没有变化。了解在实践中实现的成本平衡可以帮助人们了解未来在这种情况下改变检测政策、检测成本、治疗资格或药物价格的效果。
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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.

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来源期刊
Journal of Cancer Policy
Journal of Cancer Policy Medicine-Health Policy
CiteScore
2.40
自引率
7.70%
发文量
47
审稿时长
65 days
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