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dc.contributor.authorBeresford, L.
dc.contributor.authorMurphy, P.
dc.contributor.authorDias, S.
dc.contributor.authorClaxton, L.
dc.contributor.authorLlewellyn, A.
dc.contributor.authorWalton, M.
dc.contributor.authorMetcalf, Robert
dc.contributor.authorSchlecht, H.
dc.contributor.authorOttensmeier, C.
dc.contributor.authorPereira, M.
dc.contributor.authorHodgson, R.
dc.date.accessioned2021-03-08T06:18:42Z
dc.date.available2021-03-08T06:18:42Z
dc.date.issued2020en
dc.identifier.citationBeresford L, Murphy P, Dias S, Claxton L, Llewellyn A, Walton M, et al. Could the cost of genomic testing challenge the economic viability of new histology-independent cancer therapies? Medical Decision Making. 2020;40(5):E433-E4.en
dc.identifier.urihttp://hdl.handle.net/10541/623764
dc.description.abstractPurpose: Two histology independent therapies, entrectinib and larotrectinib, have recently been approved for use in any patient with advanced and metastatic cancer harbouring an NTRK gene fusion. Although this represents an important step-change in the treatment of cancer patients, there are novel challenges that need to be considered before implementing these drugs in a healthcare setting. This study aims to assess how the cost of genomic testing may influence the overall costeffectiveness of histology independent Trk-inhibitors, and how cost-effective it would be to implement pan-cancer NTRK testing in England. Method(s): Using the prevalence of NTRK fusions for 31 tumour types, tumour-specific testing costs were calculated for three testing strategies. These testing costs were used to inform an illustrative economic analysis, whereby the tumour-specific incremental cost-effectiveness ratio (ICER) of pan-cancer NTRK fusion testing was estimated using the calculated testing costs and an estimated incremental benefit of 0.833 QALYs (Canadian Agency for Drugs and Technologies in Health, 2019). Result(s): Owing to substantial differences in the prevalence of NTRK fusions across tumour types, the number of patients needing to be screened to identify one eligible individual for Trk-inhibitors ranged from 1.1 (Mammary Analogue Secretory Carcinoma) to 2000 (High Grade Glioma) patients. Based on the testing costs alone, the average incremental cost of testing to identify one eligible individual ranged between £83,183 and £199,629 per patient identified, dependent upon testing strategy adopted. Tumour-specific incremental costs ranged from £0 to £1,479,655 per patient identified. Estimates of tumour-specific cost-effectiveness varied from less than £500/QALY in some rare cancers to over £200,000/QALY for some common cancers. Based on the cost of genomic testing alone, it was estimated that genomic testing was unlikely to be costeffective in 19 of the tumour types known to harbour an NTRK fusion at a willingness to pay threshold of £50,000/QALY. Conclusion(s): The rarity of NTRK fusions means that the costs of testing are high for most tumour types. This is likely to considerably impact the cost-effectiveness of TRK inhibitors. Consequently, the expansion of genomic testing services to include pan-cancer testing does not represent value for money. Trk-inhibitors are, however, feasibly cost-effective for some tumour types. The costeffectiveness of Trk-inhibitors in other tumour types may be improved if costs of testing could be shared across multiple agents.en
dc.language.isoenen
dc.titleCould the cost of genomic testing challenge the economic viability of new histology-independent cancer therapies?en
dc.typeMeetings and Proceedingsen
dc.contributor.departmentCentre for Reviews and Dissemination, University of York, Yorken
dc.identifier.journalMedical Decision Makingen
dc.description.noteen]


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