title: Cost-effectiveness of gene-expression profiling for tumor-site origin.
abstract: OBJECTIVE
  Gene-expression profiling (GEP) reliably supplements traditional clinicopathological information on the tissue of origin (TOO) in metastatic or poorly differentiated cancer. A cost-effectiveness analysis of GEP TOO testing versus usual care was conducted from a US third-party payer perspective.
  
  
  METHODS
  Data on recommendation changes for chemotherapy, surgery, radiation therapy, blood tests, imaging investigations, and hospice care were obtained from a retrospective, observational study of patients whose physicians received GEP TOO test results. The effects of chemotherapy recommendation changes on survival were based on the results of trials cited in National Comprehensive Cancer Network and UpToDate guidelines. Drug and administration costs were based on average doses reported in National Comprehensive Cancer Network guidelines. Other unit costs came from Centers for Medicare & Medicaid Services fee schedules. Quality-of-life weights were obtained from literature. Bootstrap analysis estimated sample variability; probabilistic sensitivity analysis addressed parameter uncertainty.
  
  
  RESULTS
  Chemotherapy regimen recommendations consistent with guidelines for final tumor-site diagnoses increased significantly from 42% to 65% (net difference 23%; P<0.001). Projected overall survival increased from 15.9 to 19.5 months (mean difference 3.6 months; two-sided 95% confidence interval [CI] 3.2-3.9). The average increase in quality-adjusted life-months was 2.7 months (95% CI 1.5-4.3), and average third-party payer costs per patient increased by $10,360 (95% CI $2,982-$19,192). The cost per quality-adjusted life-year gained was $46,858 (95% CI $13,351-$104,269).
  
  
  CONCLUSIONS
  GEP TOO testing significantly altered clinical practice patterns and is projected to increase overall survival, quality-adjusted life-years, and costs, resulting in an expected cost per quality-adjusted life-year of less than $50,000.
authors: Cedar Associates LLC, Menlo Park, CA 94025, USA. ujch@stanford.edu
authors: John
authors: J
authors: Hornberger
authors: Irina
authors: I
authors: Degtiar
authors: Hialy
authors: H
authors: Gutierrez
authors: Ashwini
authors: A
authors: Shewade
authors: W David
authors: WD
authors: Henner
authors: Shawn
authors: S
authors: Becker
authors: Gauri
authors: G
authors: Varadhachary
authors: Gauri
authors: G
authors: Varadachary
authors: Stephen
authors: S
authors: Raab
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics / Q000379:methods*; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000235:genetics / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014481:United States
chemical_list: D000970:Antineoplastic Agents