title: Economic evaluation of targeted cancer interventions: critical review and recommendations.
abstract: Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. elkine@mskcc.org
authors.forename: Elena B
authors.initials: EB
authors.lastname: Elkin
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
authors.forename: Nathalie A
authors.initials: NA
authors.lastname: Kulin
authors.forename: Ilia L
authors.initials: IL
authors.lastname: Ferrusi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hassett
authors.forename: Uri
authors.initials: U
authors.lastname: Ladabaum
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Phillips
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy / Q000191:economics*; D040242:Risk Reduction Behavior