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Estimated Cost of Anticancer Therapy Directed by Comprehensive Genomic Profiling in a Single-Center Study
Anita Chawla1, Filip Janku1, Jennifer J Wheler1
1, , and , Analysis Group, Boston; , , and , Foundation Medicine, Cambridge, MA; and and , The University of Texas MD Anderson Cancer Center, Houston, TX.
Purpose:
Comprehensive genomic profiling (CGP) detects several classes of genomic alterations across numerous genes simultaneously and can match more patients with genomically targeted therapies than conventional molecular profiling. The current study estimated the costs of anticancer drugs and overall survival (OS) for patients who were treated with matched and unmatched therapy.
Methods:
Costs were estimated for patients with complete data (188 of 500 patients) from a prospective, nonrandomized study of patients with diverse refractory cancers who underwent CGP and were treated with matched or unmatched therapy. We assessed mean time to treatment failure (TTF) and mean observed OS. Patient-specific drug and administration costs were imputed for the first regimen after CGP on the basis of drug classes, unit costs, and time on treatment.
Results:
Patients on matched (n = 122) versus unmatched (n = 66) therapy had longer mean TTF (+1.5 months) and observed OS (+2.4 months) and higher drug costs (+$38,065; all P < .01). Increased drug costs were largely attributable to the longer duration of therapy associated with extended TTF (66.3%) rather than higher monthly drug costs (33.7%). Incremental increases in TTF (+1.9 months v +1.2 months) and observed OS (+2.5 months v +2.1 months) between matched and unmatched therapies were larger for those who underwent CGP in earlier- versus later-line therapy. Incremental increases in drug costs between matched and unmatched therapies were lower for earlier- compared with later-line therapy (+$27,000 v +$43,000, respectively).
Conclusion:
Matched therapy was associated with longer TTF, increased OS, and manageable incremental cost increases compared with unmatched therapy. Most of these increased costs were a result of the longer duration of therapy rather than higher monthly drug costs. The benefits of matching were numerically greater in earlier versus later lines of therapy, which is consistent with the value of early use of CGP.
Insights
Comprehensive genomic profiling (CGP) matched therapy improves outcomes like overall survival (OS) and time to treatment failure (TTF) with manageable cost increases. Early CGP use offers greater benefits.
Area of Science:
- Oncology
- Genomics
- Health Economics
Background:
- Comprehensive genomic profiling (CGP) enables simultaneous detection of diverse genomic alterations.
- CGP facilitates matching patients to genomically targeted therapies, potentially improving outcomes over conventional molecular profiling.
Purpose of the Study:
- To estimate the costs of anticancer drugs and overall survival (OS) for patients treated with CGP-matched versus unmatched therapies.
- To evaluate the impact of therapy line on the benefits and costs of matched therapy.
Main Methods:
- A prospective, nonrandomized study included 188 patients with refractory cancers who underwent CGP.
- Costs and outcomes (time to treatment failure [TTF], OS) were analyzed for patients receiving matched or unmatched therapy.
- Patient-specific drug costs were imputed based on regimen, unit costs, and treatment duration.
Main Results:
- Matched therapy (n=122) demonstrated longer mean TTF (+1.5 months) and OS (+2.4 months) compared to unmatched therapy (n=66), with higher drug costs (+$38,065).
- Increased costs were primarily due to longer treatment duration (66.3%) rather than higher monthly drug expenses (33.7%).
- Benefits (TTF, OS) and cost-effectiveness of matched therapy were more pronounced in earlier lines of treatment.
Conclusions:
- Matched therapy, guided by CGP, is associated with improved TTF and OS and manageable incremental costs.
- Higher costs are mainly driven by extended treatment duration, not increased monthly drug expenses.
- Early application of CGP for therapy matching yields greater clinical and economic advantages.
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