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Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary

The Pharmacogenomics Journal volume 17, pages 286–300 (2017)Cite this article

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Abstract

We aimed to investigate the cost-effectiveness of a 2000-gene-expression profiling (GEP) test to help identify the primary tumor site when clinicopathological diagnostic evaluation was inconclusive in patients with cancer of unknown primary (CUP). We built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The model was parameterized using follow-up data from the Manitoba Cancer Registry, cost data from Manitoba Health administrative databases and secondary sources. The 2000-GEP-based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was $36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test’s clinical impact was $4.2 million per year. The 2000-GEP test should be considered for adoption in CUP. Field evaluations of the test are associated with a large societal benefit.

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Acknowledgements

We thank the Department of Epidemiology and Cancer Registry of CancerCare Manitoba and Manitoba Health, Healthy Living and Seniors for its support throughout the study. The results and conclusions are those of the authors, and no official endorsement by Manitoba Health, Healthy Living and Seniors is intended or should be inferred. This work was supported by the Canadian Institutes of Health Research (CIHR) [Operating Grant #231890; GSZ (PI)]; the CIHR Strategic Training Program in Cancer Research and Technology Transfer (CaRTT) and Academic Development Grant from Western University to MBH; the Canada Research Chairs program to GSZ, PKR and SMM; and the Great-West Life, London Life and Canada Life Junior Investigator of the Canadian Cancer Society [Grant # 2011-700644] to SMM.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics. Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

    M B Hannouf, S Sarma, G Rodrigues & G S Zaric

  2. Department of Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

    E Winquist, M Brackstone & P Rogan

  3. Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

    S M Mahmud

  4. Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

    M Brackstone

  5. Department of Radiation Oncology, London Regional Cancer Program, London, Canada

    G Rodrigues

  6. Department of Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

    P Rogan

  7. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

    J S Hoch

  8. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

    J S Hoch

  9. Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada

    J S Hoch

  10. Ivey Business School, Western University, London, Ontario, Canada

    G S Zaric

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Hannouf, M., Winquist, E., Mahmud, S. et al. Cost-effectiveness of using a gene expression profiling test to aid in identifying the primary tumour in patients with cancer of unknown primary. Pharmacogenomics J 17, 286–300 (2017). https://doi.org/10.1038/tpj.2015.94

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