Comparative Economics of a 12-Gene Assay for Predicting Risk of Recurrence in Stage II Colon Cancer

Steven Robert Alberts, Tiffany M. Yu, Robert J. Behrens, Lindsay A. Renfro, Geetika Srivastava, Gamini S. Soori, Shaker R. Dakhil, Rex B. Mowat, John P. Kuebler, George P. Kim, Miroslaw A. Mazurczak, John Hornberger

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Prior economic analysis that compared the 12-gene assay to published patterns of care predicted the assay would improve outcomes while lowering medical costs for stage II, T3, mismatch-repair-proficient (MMR-P) colon cancer patients. This study assessed the validity of those findings with real-world adjuvant chemotherapy (aCT) recommendations from the US third-party payer perspective.

Methods: Costs and quality-adjusted life-years (QALYs) were estimated for stage II, T3, MMR-P colon cancer patients using guideline-compliant, state-transition probability estimation methods in a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium provided aCT recommendations before and after knowledge of the 12-gene assay results. Progression and adverse events data with aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2014 Medicare Fee Schedule. Sensitivity analyses evaluated the drivers and robustness of the primary outcomes.

Results: After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22 %; fluoropyrimidine monotherapy and FOLFOX recommendations each declined 11 %. Average per-patient drugs, administration, and adverse events costs decreased $US2,339, $US733, and $US3,211, respectively. Average total direct medical costs decreased $US991. Average patient well-being improved by 0.114 QALYs. Savings are expected to persist even if the cost of oxaliplatin drops by >75 % due to generic substitution.

Conclusions: This study provides evidence that real-world changes in aCT recommendations due to the 12-gene assay are likely to reduce direct medical costs and improve well-being for stage II, T3, MMR-P colon cancer patients.

Original languageEnglish (US)
Pages (from-to)1231-1243
Number of pages13
JournalPharmacoEconomics
Volume32
Issue number12
DOIs
StatePublished - Nov 26 2014

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Adjuvant Chemotherapy
Colonic Neoplasms
Economics
Costs and Cost Analysis
Recurrence
DNA Mismatch Repair
Genes
oxaliplatin
Quality-Adjusted Life Years
Fee Schedules
Drug Substitution
Health Insurance Reimbursement
Drug Costs
Medicare
Drug-Related Side Effects and Adverse Reactions
Guidelines
Physicians
Research
Neoplasms

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Alberts, S. R., Yu, T. M., Behrens, R. J., Renfro, L. A., Srivastava, G., Soori, G. S., ... Hornberger, J. (2014). Comparative Economics of a 12-Gene Assay for Predicting Risk of Recurrence in Stage II Colon Cancer. PharmacoEconomics, 32(12), 1231-1243. https://doi.org/10.1007/s40273-014-0207-1

Comparative Economics of a 12-Gene Assay for Predicting Risk of Recurrence in Stage II Colon Cancer. / Alberts, Steven Robert; Yu, Tiffany M.; Behrens, Robert J.; Renfro, Lindsay A.; Srivastava, Geetika; Soori, Gamini S.; Dakhil, Shaker R.; Mowat, Rex B.; Kuebler, John P.; Kim, George P.; Mazurczak, Miroslaw A.; Hornberger, John.

In: PharmacoEconomics, Vol. 32, No. 12, 26.11.2014, p. 1231-1243.

Research output: Contribution to journalArticle

Alberts, SR, Yu, TM, Behrens, RJ, Renfro, LA, Srivastava, G, Soori, GS, Dakhil, SR, Mowat, RB, Kuebler, JP, Kim, GP, Mazurczak, MA & Hornberger, J 2014, 'Comparative Economics of a 12-Gene Assay for Predicting Risk of Recurrence in Stage II Colon Cancer', PharmacoEconomics, vol. 32, no. 12, pp. 1231-1243. https://doi.org/10.1007/s40273-014-0207-1
Alberts, Steven Robert ; Yu, Tiffany M. ; Behrens, Robert J. ; Renfro, Lindsay A. ; Srivastava, Geetika ; Soori, Gamini S. ; Dakhil, Shaker R. ; Mowat, Rex B. ; Kuebler, John P. ; Kim, George P. ; Mazurczak, Miroslaw A. ; Hornberger, John. / Comparative Economics of a 12-Gene Assay for Predicting Risk of Recurrence in Stage II Colon Cancer. In: PharmacoEconomics. 2014 ; Vol. 32, No. 12. pp. 1231-1243.
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abstract = "Background: Prior economic analysis that compared the 12-gene assay to published patterns of care predicted the assay would improve outcomes while lowering medical costs for stage II, T3, mismatch-repair-proficient (MMR-P) colon cancer patients. This study assessed the validity of those findings with real-world adjuvant chemotherapy (aCT) recommendations from the US third-party payer perspective.Methods: Costs and quality-adjusted life-years (QALYs) were estimated for stage II, T3, MMR-P colon cancer patients using guideline-compliant, state-transition probability estimation methods in a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium provided aCT recommendations before and after knowledge of the 12-gene assay results. Progression and adverse events data with aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2014 Medicare Fee Schedule. Sensitivity analyses evaluated the drivers and robustness of the primary outcomes.Results: After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22 {\%}; fluoropyrimidine monotherapy and FOLFOX recommendations each declined 11 {\%}. Average per-patient drugs, administration, and adverse events costs decreased $US2,339, $US733, and $US3,211, respectively. Average total direct medical costs decreased $US991. Average patient well-being improved by 0.114 QALYs. Savings are expected to persist even if the cost of oxaliplatin drops by >75 {\%} due to generic substitution.Conclusions: This study provides evidence that real-world changes in aCT recommendations due to the 12-gene assay are likely to reduce direct medical costs and improve well-being for stage II, T3, MMR-P colon cancer patients.",
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AU - Renfro, Lindsay A.

AU - Srivastava, Geetika

AU - Soori, Gamini S.

AU - Dakhil, Shaker R.

AU - Mowat, Rex B.

AU - Kuebler, John P.

AU - Kim, George P.

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N2 - Background: Prior economic analysis that compared the 12-gene assay to published patterns of care predicted the assay would improve outcomes while lowering medical costs for stage II, T3, mismatch-repair-proficient (MMR-P) colon cancer patients. This study assessed the validity of those findings with real-world adjuvant chemotherapy (aCT) recommendations from the US third-party payer perspective.Methods: Costs and quality-adjusted life-years (QALYs) were estimated for stage II, T3, MMR-P colon cancer patients using guideline-compliant, state-transition probability estimation methods in a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium provided aCT recommendations before and after knowledge of the 12-gene assay results. Progression and adverse events data with aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2014 Medicare Fee Schedule. Sensitivity analyses evaluated the drivers and robustness of the primary outcomes.Results: After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22 %; fluoropyrimidine monotherapy and FOLFOX recommendations each declined 11 %. Average per-patient drugs, administration, and adverse events costs decreased $US2,339, $US733, and $US3,211, respectively. Average total direct medical costs decreased $US991. Average patient well-being improved by 0.114 QALYs. Savings are expected to persist even if the cost of oxaliplatin drops by >75 % due to generic substitution.Conclusions: This study provides evidence that real-world changes in aCT recommendations due to the 12-gene assay are likely to reduce direct medical costs and improve well-being for stage II, T3, MMR-P colon cancer patients.

AB - Background: Prior economic analysis that compared the 12-gene assay to published patterns of care predicted the assay would improve outcomes while lowering medical costs for stage II, T3, mismatch-repair-proficient (MMR-P) colon cancer patients. This study assessed the validity of those findings with real-world adjuvant chemotherapy (aCT) recommendations from the US third-party payer perspective.Methods: Costs and quality-adjusted life-years (QALYs) were estimated for stage II, T3, MMR-P colon cancer patients using guideline-compliant, state-transition probability estimation methods in a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium provided aCT recommendations before and after knowledge of the 12-gene assay results. Progression and adverse events data with aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2014 Medicare Fee Schedule. Sensitivity analyses evaluated the drivers and robustness of the primary outcomes.Results: After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22 %; fluoropyrimidine monotherapy and FOLFOX recommendations each declined 11 %. Average per-patient drugs, administration, and adverse events costs decreased $US2,339, $US733, and $US3,211, respectively. Average total direct medical costs decreased $US991. Average patient well-being improved by 0.114 QALYs. Savings are expected to persist even if the cost of oxaliplatin drops by >75 % due to generic substitution.Conclusions: This study provides evidence that real-world changes in aCT recommendations due to the 12-gene assay are likely to reduce direct medical costs and improve well-being for stage II, T3, MMR-P colon cancer patients.

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