Economic impact of genomic diagnostics for intermediate-risk acute myeloid leukaemia.
Acute Myeloid Leukaemia (AML) is a rare but serious group of diseases that require critical decision-making for curative treatment. Over the past decade, scientific discovery has revealed dozens of prognostic gene mutations for AML while sequencing costs have plummeted. In this study, we compared the cost-effectiveness of multigene integrative analysis (genomic analysis) with the standard molecular testing currently used for diagnosis of intermediate-risk AML. We used a decision analytic model with data for costs and outcomes from British Columbia, Canada, to assess the long-term (10-year) economic impacts. Our results suggest that genomic analysis would result in a 26% increase in the use of first-remission allogeneic stem cell transplantation. The resulting treatment decisions and downstream effects would come at an additional cost of $12 556 [2013 Canadian dollars (CAD)] per person and the incremental cost-effectiveness ratio would be $49 493 per quality-adjusted life-year gained. Cost-effectiveness was dependent on quality of life during the long-term (5-10) years of survival, relapse rates following first-remission chemotherapy and the upfront cost of transplantation. Non-relapse mortality rates, short-term quality of life and the cost of genomic sequencing had only minor impacts. Further research on post-remission outcomes can lead to improvements in the cost-effectiveness of curative treatments for AML.
Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.|Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.
Sonya
S
Cressman
Centre for Clinical Genomics, Michael Smith Genome Sciences Centre, Vancouver, BC, Canada.|Cancer Genetics Laboratory, British Columbia Cancer Agency, Vancouver, BC, Canada.|Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Aly
A
Karsan
Terry Fox Laboratories, British Columbia Cancer Research Centre, Vancouver, BC, Canada.|Leukemia Bone Marrow Transplant Program of BC, Vancouver General Hospital, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Donna E
DE
Hogge
Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.|Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.
Emily
E
McPherson
Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.|Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Corneliu
C
Bolbocean
Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.|Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.|School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Dean A
DA
Regier
Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC, Canada.|Department of Cancer Control, BC Cancer Research Centre, Vancouver, BC, Canada.|Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
Stuart J
SJ
Peacock
D000328:Adult; D002170:Canada; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D023281:Genomics; D018380:Hematopoietic Stem Cell Transplantation / Q000191:economics; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
Cost-effectiveness; first remission treatment; genomic analysis; intermediate-risk AML