title: A multigene prognostic assay for selection of adjuvant chemotherapy in patients with T3, stage II colon cancer: impact on quality-adjusted life expectancy and costs.
abstract: OBJECTIVE
  Uncertainty exists regarding appropriate and affordable use of adjuvant chemotherapy in stage II colon cancer (T3, proficient DNA mismatch repair). This study aimed to estimate the effectiveness and costs from a US societal perspective of a multigene recurrence score (RS) assay for patients recently diagnosed with stage II colon cancer (T3, proficient DNA mismatch repair) eligible for adjuvant chemotherapy.
  
  
  METHODS
  RS was compared with guideline-recommended clinicopathological factors (tumor stage, lymph nodes examined, tumor grade, and lymphovascular invasion) by using a state-transition (Markov) lifetime model. Data were obtained from published literature, a randomized controlled trial (QUick And Simple And Reliable) of adjuvant chemotherapy, and rates of chemotherapy use from the National Cooperative Cancer Network Colon/Rectum Cancer Outcomes study. Life-years, quality-adjusted life expectancy, and lifetime costs were examined.
  
  
  RESULTS
  The RS is projected to reduce adjuvant chemotherapy use by 17% compared with current treatment patterns and to increase quality-adjusted life expectancy by an average of 0.035 years. Direct medical costs are expected to decrease by an average of $2971 per patient. The assay was cost saving for all subgroups of patients stratified by clinicopathologic factors. The most influential variables affecting treatment decisions were projected years of life remaining, recurrence score, and patients' disutilities associated with adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Use of the multigene RS to assess recurrence risk after surgery in stage II colon cancer (T3, proficient DNA mismatch repair) may reduce the use of adjuvant chemotherapy without decreasing quality-adjusted life expectancy and be cost saving from a societal perspective. These findings need to be validated in additional cohorts, including studies of clinical practice as assay use diffuses into nonacademic settings.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. ujch@stanford.edu
authors.forename: John
authors.initials: J
authors.lastname: Hornberger
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chien
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000191:economics*; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D003362:Cost-Benefit Analysis; D006801:Humans; D008017:Life Expectancy; D008390:Markov Chains; D009364:Neoplasm Recurrence, Local / Q000191:economics / Q000517:prevention & control; D009367:Neoplasm Staging; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D014481:United States