OBJECTIVE:
To assess the cost-effectiveness of a strategy employing genomic-based
tumor testing to guide therapy for platinum-resistant ovarian cancer.
METHODS:
A
decision model was created to compare standard of care (SOC) cytotoxic
chemotherapy to a genomic-based treatment strategy. The genomic arm
included tumor testing with treatment directed at targets identified.
Overall survival was assumed to be similar between strategies; quality
of life (QOL) was assumed superior during targeted therapy compared to
chemotherapy. Pertinent uncertainties (cost of targeted therapy and
genomic testing, response to targeted therapy, probability of a tumor
having a targetable alteration, and impact on QOL) were evaluated in a
series of one-and two-way sensitivity analyses.
RESULTS:
The
genomic testing strategy was more expensive ($90,271 vs. $74,926) per
patient than SOC. The incremental cost-effectiveness ratio (ICER) of the
genomic strategy was $479,303 per quality-adjusted life year saved
(QALY). Model results were insensitive to the cost of genomic testing,
differences in QOL, and the probability of identifying a targetable
alteration. However, the model was sensitive to the cost of targeted
therapy. For example, when the cost of targeted therapy was reduced to
56% of its current cost (or $6400/cycle), the genomic strategy became
more cost-effective with an ICER of $96,612/QALY.
CONCLUSIONS:
Genomic-based
tumor testing and targeted therapy in patients with platinum-resistant
ovarian cancer is not cost-effective compared with SOC. However,
reducing the cost of targeted therapy (independently, or in combination
with reducing the cost of the genomic test) provides opportunities for
improved value in cancer care.
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