title: Cost-effectiveness of the Decipher Genomic Classifier to Guide Individualized Decisions for Early Radiation Therapy After Prostatectomy for Prostate Cancer.
abstract: Controversy exists regarding the effectiveness of early adjuvant versus salvage radiation therapy after prostatectomy for prostate cancer. Estimates of prostate cancer progression from the Decipher genomic classifier (GC) could guide informed decision-making and improve the outcomes for patients.
  
  
  
  We developed a Markov model to compare the costs and quality-adjusted life years (QALYs) associated with GC-based treatment decisions regarding adjuvant therapy after prostatectomy with those of 2 control strategies: usual care (determined from patterns of care studies) and the alternative of 100% adjuvant radiation therapy. Using the bootstrapping method of sampling with replacement, the cases of 10,000 patients were simulated during a 10-year time horizon, with each subject having individual estimates for cancer progression (according to GC findings) and noncancer mortality (according to age).
  
  
  
  GC-based care was more effective and less costly than 100% adjuvant radiation therapy and resulted in cost savings up to an assay cost of $11,402. Compared with usual care, GC-based care resulted in more QALYs. Assuming a $4000 assay cost, the incremental cost-effectiveness ratio was $90,833 per QALY, assuming a 7% usage rate of adjuvant radiation therapy. GC-based care was also associated with a 16% reduction in the percentage of patients with distant metastasis at 5 years compared with usual care.
  
  
  
  The Decipher GC could be a cost-effective approach for genomics-driven cancer treatment decisions after prostatectomy, with improvements in estimated clinical outcomes compared with usual care. The individualized decision analytic framework applied in the present study offers a flexible approach to estimate the potential utility of genomic assays for personalized cancer medicine.
authors.affiliation: Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA. Electronic address: jem4yb@virginia.edu.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Lobo
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Trifiletti
authors.affiliation: Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Sturz
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
authors.affiliation: GenomeDx Biosciences, Vancouver, BC, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Buerki
authors.affiliation: GenomeDx Biosciences, Vancouver, BC, Canada.
authors.forename: Elai
authors.initials: E
authors.lastname: Davicioni
authors.affiliation: Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Karnes
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Jenkins
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Cancer Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Den
authors.affiliation: Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
mesh_terms: D000066491:Clinical Decision-Making; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D023281:Genomics / Q000191:economics*; D006801:Humans; D008297:Male; D008390:Markov Chains; D057285:Precision Medicine; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000235:genetics / Q000532:radiotherapy* / Q000601:surgery*; D019057:Quality-Adjusted Life Years
keywords: Adjuvant and salvage radiation therapy; Cost-effectiveness analysis; Individualized medicine; Molecular assay; Prostatic neoplasms