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SUMMARY:Cost-effectiveness analysis of multiplex targeted sequencing in lu
 ng adenocarcinoma - Brett Doble\, University of Cambridge\, Cambridge Cent
 re for Health Services Research
DTSTART:20160125T150000Z
DTEND:20160125T160000Z
UID:TALK59159@talks.cam.ac.uk
CONTACT:Ed Wilson
DESCRIPTION:Objectives: To identify parameters that drive the cost-effecti
 veness of precision medicine by comparing the use of multiplex targeted se
 quencing (MTS) to select targeted therapy based on tumour genomic profiles
  to either no further testing with chemotherapy or no further testing with
  best supportive care in the last-line treatment of metastatic lung adenoc
 arcinoma.\n\nMaterials and Methods: A combined decision tree and Markov mo
 del was developed to compare costs\, life-years (LYs)\, and quality-adjust
 ed life-years (QALYs) over a five-year time horizon from an Australian hea
 lthcare payer perspective. The published literature and a population-based
  molecular cohort study (Cancer 2015) were used as the main sources of dat
 a. Parameter uncertainty was assessed using deterministic sensitivity anal
 yses and value of information analyses\, while uncertainty due to technolo
 gical/scientific advancement was assessed by conducting a number of plausi
 ble future scenario analyses. \n\nResults: Given the current evidence base
 \, the cost-effectiveness of MTS is questionable for selecting targeted th
 erapy in the last-line treatment of metastatic lung adenocarcinoma. Reduce
 d costs of off-label targeted therapy\, lower health state utility values 
 for progressive disease\, and targeted therapy resulting in reductions in 
 outpatient\, emergency\, and inpatient visits\, however\, all resulted in 
 more favourable cost-effectiveness estimates for MTS. The expected value t
 o decision makers of removing all current decision uncertainty was estimat
 ed to be $12\,890\,000\, indicating that additional research to reduce par
 ameter uncertainty may be a worthwhile investment. Future scenarios analys
 es revealed that reducing test turn-around-time improved the cost-effectiv
 eness of MTS\, whereas decreasing sequencing costs had little impact. For 
 MTS to have an incremental cost-effectiveness ratio of $100\,000/QALY\, 50
 % of identified mutations have to be actionable when off-label targeted th
 erapy costs $1500/week and 100% of patients tested have a mutation identif
 ied.\n\nConclusion: An iterative process to the economic evaluation of MTS
  will be necessary as our understanding of its impact on health outcomes a
 nd the health budget improves.
LOCATION:Thomas and Dorothy Strangeways Room\, Strangeways Research Labora
 tory\, Wort’s Causeway\, Cambridge\, CB1 8RN
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