title: Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary.
abstract: We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. The 2000-GEP-based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was $36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test's clinical impact was $4.2 million per year. The 2000-GEP test should be considered for adoption in CUP. Field evaluations of the test are associated with a large societal benefit.
authors.affiliation: Department of Epidemiology and Biostatistics. Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: M B
authors.initials: MB
authors.lastname: Hannouf
authors.affiliation: Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: E
authors.initials: E
authors.lastname: Winquist
authors.affiliation: Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: S M
authors.initials: SM
authors.lastname: Mahmud
authors.affiliation: Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Brackstone
authors.affiliation: Department of Epidemiology and Biostatistics. Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Sarma
authors.affiliation: Department of Radiation Oncology, London Regional Cancer Program, London, Canada.|Department of Epidemiology and Biostatistics. Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Rodrigues
authors.affiliation: Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Rogan
authors.affiliation: Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.|Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: Ivey Business School, Western University, London, Ontario, Canada.|Department of Epidemiology and Biostatistics. Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: G S
authors.initials: GS
authors.lastname: Zaric
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics*; D002017:Budgets; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D020869:Gene Expression Profiling / Q000191:economics* / Q000379:methods; D015972:Gene Expression Regulation, Neoplastic; D020022:Genetic Predisposition to Disease; D017048:Health Care Costs; D006801:Humans; D008350:Manitoba; D008390:Markov Chains; D018803:Models, Economic; D009382:Neoplasms, Unknown Primary / Q000191:economics* / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D012042:Registries; D013997:Time Factors; D059467:Transcriptome
chemical_list: D014408:Biomarkers, Tumor