title: A Cost-Effectiveness Analysis of Using the JBR.10-Based 15-Gene Expression Signature to Guide Adjuvant Chemotherapy in Early Stage Non-Small-Cell Lung Cancer.
abstract: Adjuvant chemotherapy (ACT) improved survival in the NCIC Clinical Trials Group JBR.10 trial of resected stage IB/II non-small-cell lung cancer. A prognostic 15-gene expression signature was developed, which may also predict for benefit from ACT. An exploratory economic analysis was conducted to assess the potential cost-effectiveness of using the 15-gene signature in guiding ACT decisions.
  
  
  
  A decision analytic model was populated by study patients with quantitative reverse transcription polymerase chain reaction tumor profiling, current costs, and quality-adjusted survival. Analysis was performed over the 6-year follow-up from the perspective of the Canadian public health care system in 2015 Canadian dollars (discounted 5%/year). Incremental cost-effectiveness and cost-utility ratios were determined for ACT versus observation using clinical stage, gene signature, or a combined approach to select treatment.
  
  
  
  The mean survival gain of ACT versus observation was higher using the gene signature (1.86 years) compared with clinical stage (1.28 years). Although more costly, ACT guided by the gene signature remained cost-effective at $10,421/life-year gained (95% confidence interval [CI], $466-$19,568 Canadian), comparable to stage-directed selection ($7081/life-year gained; 95% CI, -$2370 to $14,721; P = .52). Incremental cost-utility ratios were $13,452/quality-adjusted life-year (95% CI, $373-$31,949) and $9194/quality-adjusted life-year (95% CI, -$4104 to $23,952), respectively (P = .53). Comparing the standard and test-and-treat approaches, use of the gene signature did not significantly alter survival compared with the standard strategy, but it reduced the ACT rate by 25%.
  
  
  
  If validated, the use of the 15-gene expression signature to select patients for ACT may increase the survival gain of treatment in patients with high-risk stage IB/II non-small-cell lung cancer, while avoiding toxicities in low-risk patients.
authors: Division of Oncology, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors: Kit Man
authors: KM
authors: Wong
authors: National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
authors: Keyue
authors: K
authors: Ding
authors: National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
authors: Suzanne
authors: S
authors: Li
authors: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Penelope
authors: P
authors: Bradbury
authors: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Ming-Sound
authors: MS
authors: Tsao
authors: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Sandy D
authors: SD
authors: Der
authors: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Frances A
authors: FA
authors: Shepherd
authors: Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Carmen
authors: C
authors: Chung
authors: National Cancer Center Singapore, Singapore.
authors: Raymond
authors: R
authors: Ng
authors: National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada.
authors: Lesley
authors: L
authors: Seymour
authors: Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Electronic address: natasha.leighl@uhn.ca.
authors: Natasha B
authors: NB
authors: Leighl
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000235:genetics; D002170:Canada; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D015996:Survival Rate; D059467:Transcriptome
chemical_list: D014408:Biomarkers, Tumor
keywords: Economic analysis; Incremental cost-effectiveness ratio; Incremental cost-utility ratio; Predictive marker; Sensitivity analysis