Early-stage economic analysis of research-based comprehensive genomic sequencing for advanced cancer care View Full Text


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Article Info

DATE

2021-11-29

AUTHORS

Deirdre Weymann, Janessa Laskin, Steven J. M. Jones, Robyn Roscoe, Howard J. Lim, Daniel J. Renouf, Kasmintan A. Schrader, Sophie Sun, Stephen Yip, Marco A. Marra, Dean A. Regier

ABSTRACT

Genomic research is driving discovery for future population benefit. Limited evidence exists on immediate patient and health system impacts of research participation. This study uses real-world data and quasi-experimental matching to examine early-stage cost and health impacts of research-based genomic sequencing. British Columbia’s Personalized OncoGenomics (POG) single-arm program applies whole genome and transcriptome analysis (WGTA) to characterize genomic landscapes in advanced cancers. Our cohort includes POG patients enrolled between 2014 and 2015 and 1:1 genetic algorithm–matched usual care controls. We undertake a cost consequence analysis and estimate 1-year effects of WGTA on patient management, patient survival, and health system costs reported in 2015 Canadian dollars. WGTA costs are imputed and forecast using system of equations modeling. We use Kaplan-Meier survival analysis to explore survival differences and inverse probability of censoring weighted linear regression to estimate mean 1-year survival times and costs. Non-parametric bootstrapping simulates sampling distributions and enables scenario analysis, revealing drivers of incremental costs, survival, and net monetary benefit for assumed willingness to pay thresholds. We identified 230 POG patients and 230 matched controls for cohort inclusion. The mean period cost of research-funded WGTA was $26,211 (SD: $14,191). Sequencing costs declined rapidly, with WGTA forecasts hitting $13,741 in 2021. The incremental healthcare system effect (non-research expenditures) was $5203 (95% CI: 75, 10,424) compared to usual care. No overall survival differences were observed, but outcome heterogeneity was present. POG patients receiving WGTA-informed treatment experienced incremental survival gains of 2.49 months (95% CI: 1.32, 3.64). Future cost consequences became favorable as WGTA cost drivers declined and WGTA-informed treatment rates improved to 60%. Our study demonstrates the ability of real-world data to support evaluations of only-in-research health technologies. We identify situations where precision oncology research initiatives may produce survival benefit at a cost that is within healthcare systems’ willingness to pay. This economic evidence informs the early-stage healthcare impacts of precision oncology research. More... »

PAGES

1-16

References to SciGraph publications

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    19 schema:description Genomic research is driving discovery for future population benefit. Limited evidence exists on immediate patient and health system impacts of research participation. This study uses real-world data and quasi-experimental matching to examine early-stage cost and health impacts of research-based genomic sequencing. British Columbia’s Personalized OncoGenomics (POG) single-arm program applies whole genome and transcriptome analysis (WGTA) to characterize genomic landscapes in advanced cancers. Our cohort includes POG patients enrolled between 2014 and 2015 and 1:1 genetic algorithm–matched usual care controls. We undertake a cost consequence analysis and estimate 1-year effects of WGTA on patient management, patient survival, and health system costs reported in 2015 Canadian dollars. WGTA costs are imputed and forecast using system of equations modeling. We use Kaplan-Meier survival analysis to explore survival differences and inverse probability of censoring weighted linear regression to estimate mean 1-year survival times and costs. Non-parametric bootstrapping simulates sampling distributions and enables scenario analysis, revealing drivers of incremental costs, survival, and net monetary benefit for assumed willingness to pay thresholds. We identified 230 POG patients and 230 matched controls for cohort inclusion. The mean period cost of research-funded WGTA was $26,211 (SD: $14,191). Sequencing costs declined rapidly, with WGTA forecasts hitting $13,741 in 2021. The incremental healthcare system effect (non-research expenditures) was $5203 (95% CI: 75, 10,424) compared to usual care. No overall survival differences were observed, but outcome heterogeneity was present. POG patients receiving WGTA-informed treatment experienced incremental survival gains of 2.49 months (95% CI: 1.32, 3.64). Future cost consequences became favorable as WGTA cost drivers declined and WGTA-informed treatment rates improved to 60%. Our study demonstrates the ability of real-world data to support evaluations of only-in-research health technologies. We identify situations where precision oncology research initiatives may produce survival benefit at a cost that is within healthcare systems’ willingness to pay. This economic evidence informs the early-stage healthcare impacts of precision oncology research.
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    25 Kaplan-Meier survival analysis
    26 POG patients
    27 WGTA
    28 ability
    29 advanced cancer
    30 advanced cancer care
    31 analysis
    32 assumed willingness
    33 benefits
    34 bootstrapping
    35 cancer
    36 cancer care
    37 care
    38 care control
    39 censoring
    40 cohort
    41 cohort inclusion
    42 comprehensive genomic sequencing
    43 consequence analysis
    44 consequences
    45 control
    46 cost
    47 cost consequences
    48 cost drivers
    49 cost-consequence analysis
    50 data
    51 differences
    52 discovery
    53 distribution
    54 dollars
    55 drivers
    56 economic analysis
    57 economic evidence
    58 effect
    59 equations
    60 evaluation
    61 evidence
    62 forecasts
    63 gain
    64 genome
    65 genomic landscape
    66 genomic research
    67 genomic sequencing
    68 health impacts
    69 health system costs
    70 health system impacts
    71 health technologies
    72 healthcare impact
    73 healthcare system
    74 heterogeneity
    75 immediate patients
    76 impact
    77 inclusion
    78 incremental cost
    79 incremental survival gains
    80 initiatives
    81 inverse probability
    82 landscape
    83 limited evidence
    84 linear regression
    85 management
    86 matching
    87 monetary benefits
    88 months
    89 net monetary benefit
    90 non-parametric bootstrapping
    91 oncology research
    92 outcome heterogeneity
    93 overall survival difference
    94 participation
    95 patient management
    96 patient survival
    97 patients
    98 period cost
    99 population benefits
    100 precision oncology research
    101 probability
    102 program
    103 rate
    104 real-world data
    105 regression
    106 research
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    109 scenario analysis
    110 sequencing
    111 sequencing costs
    112 situation
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    135 schema:name Early-stage economic analysis of research-based comprehensive genomic sequencing for advanced cancer care
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