Cost-Effectiveness of RAS Genetic Testing Strategies in Patients With Metastatic Colorectal Cancer: A Systematic Review

Unim, Brigid; Pitini, Erica; Vito, Corrado De; D’Andrea, Elvira; Marzuillo, Carolina

doi:10.1016/j.jval.2019.07.009

Cited by 12 publications

(7 citation statements)

References 41 publications

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“…Pharmacogenetic analysis as a strategic tool focused on Precision Medicine is a practice that has expanded into specialized fields such as Oncology. 7 Knowledge of the patient's pharmacogenotype has proved useful when considering certain treatments based on the genetic nature of certain pathologies and has in some cases been able to reduce the costs associated with hospitalizations, adverse effects and pharmacotherapies not adjusted to the pharmacokinetic and/or pharmacodynamic of the patient. [8][9][10][11][12][13][14][15][16][17][18] There is some evidence to suggest that controlling the dose of various drugs guided by the patient's genotype could reduce the costs of morbidity and mortality associated with drugs that have, in the United States alone, exceeded $177B.…”

Section: Introductionmentioning

confidence: 99%

Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients

Carrascal-Laso

Franco-Martín

Marcos-Vadillo

et al. 2021

PGPM

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Background Schizophrenia is a severe mental disorder that often manifests within the first three decades of life. Its prognosis is uncertain and may result in a prolonged treatment that could extend throughout the entire lifespan of the patient. Antipsychotic drugs are characterized by a high interindividual variability when considering therapeutic effect and emergence of adverse effects. Such interindividual variability is thought to be associated primarily with pharmacokinetic matters. Objective The objective of this study was to evaluate the economic impact of the application of the 5-Step Precision Medicine model (5SPM), an approach based on the pharmacogenetic analysis of the primary genes involved in the metabolism of the therapy for each patient, restructuring treatment as necessary. Patients and Methods One hundred eighty-eight psychiatry patients were analysed for single nucleotide polymorphisms on genes CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A5 and ABCB1. Information on patients’ diagnosis, pharmacotherapy, and hospitalizations was collected. Results We achieved a cost–benefit ratio of 3.31–3.59 with a reduction of direct cost (hospitalizations plus pharmacotherapy) with a reduction of total cost in 67% of the patients who underwent the clinical intervention. Conclusion A rational Precision Medicine-based approach to psychiatric patients could result in a reduction on number of drugs required to control exacerbations, and the underlying pathologies, reducing the risk of adverse effects and improving adherence to treatment, leading to a potential decrease in direct costs. This methodology has been shown to be cost-dominant and, being based on a pharmacogenetic analysis, it has a lifelong nature, as the data obtained can be applied to other medical disciplines.

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Section: Introductionmentioning

confidence: 99%

Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients

Carrascal-Laso

Franco-Martín

Marcos-Vadillo

et al. 2021

PGPM

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“…13,14,18 For example, testing mCRC patients for RAS status and treating only patients without RAS mutations with EGFR inhibitors are more cost-effective than treating all patients without testing. 19 Despite the increased interest in the utilization of NGS and its utility to identify patients to match with clinical trials, 8,9 underrepresentation of racially diverse patients in clinical trials has persisted. [20][21][22][23][24] Our findings, showing disparities in biomarker testing, point to potential further exacerbation of disparities in targeted therapy and clinical outcomes among those with mCRC and in clinical trial participation.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that the identification of tumor alterations can provide targeted therapy, thus improving clinical outcomes. 17 Indeed, the ability of biomarkers to improve treatment and reduce costs has been previously demonstrated, 18 , 19 including sparing patients from futile, potentially toxic and expensive treatment. 13 , 14 , 18 For example, testing mCRC patients for RAS status and treating only patients without RAS mutations with EGFR inhibitors are more cost‐effective than treating all patients without testing.…”

Section: Discussionmentioning

confidence: 99%

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Sociodemographic and clinical factors associated with receipt of biomarker testing in patients with metastatic colorectal cancer

et al. 2022

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Background Standard clinical practice and national guidelines dictate somatic testing of metastatic colorectal cancer (mCRC) tumors to guide appropriate therapy; however, previous studies suggest that not all patients are tested. The objective of this study was to investigate potential differences in testing for mCRC by demographic and clinical factors. Methods We performed a retrospective review of de‐identified patient data derived from electronic health records (EHRs) of 25,469 patients diagnosed with mCRC between the years 2013 and 2020. Our outcome was a receipt of the following tests: (a) biomarker testing (BRAF, KRAS, NRAS, MMR/MSI) and (b) next‐generation sequencing (NGS). We interrogated our data using the machine‐learning algorithm Classification and Regression Tree (CART), a unique approach to identifying combinations of, rather than individual demographic and clinical characteristics associated with receipt of testing. Results A total of 25,469 patients were identified with mCRC. Of these, 21,133 (83%) received either biomarker testing only (n = 12,485) or any testing (biomarker + NGS) (n = 8648). The proportion of patients who received any testing increased over calendar time for all age, race, and sex categories. Receipt of any testing was highest (90%) among younger and patients with better performance status, and there was no difference in receipt of any testing by race. The highest percentage of NGS testing was among those with better performance status, <70 years old, commercial or other governmental program payers, and low comorbidity burden; however, those who were Black or Hispanic had a lower prevalence of NGS testing than those who were White. Conclusions and Relevance Considerable variations exist in somatic biomarker testing across subgroups of the population. Identification of genomic alterations can aid in determining targeted treatment and improving clinical outcomes; therefore, equitable use of these testing strategies, particularly NGS, is necessary.

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“…It is worthy to note that to cater to more effective targeted therapy in CRC subjects, genetic testing to identify mutational profiles, including MSI status and both p53 and KRAS mutations, is required. In many countries, the cost for mutational screening is considered expensive and may not be accessible to the majority of the population due to a lack of technologies and facilities [ 104 ]. This hinders the progress of targeted gene therapy in CRC.…”

Section: Challengesmentioning

confidence: 99%

Gene Therapy Targeting p53 and KRAS for Colorectal Cancer Treatment: A Myth or the Way Forward?

Hasbullah

Musa

2021

IJMS

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Colorectal cancer (CRC) is the third most commonly diagnosed malignancy worldwide and is responsible as one of the main causes of mortality in both men and women. Despite massive efforts to raise public awareness on early screening and significant advancements in the treatment for CRC, the majority of cases are still being diagnosed at the advanced stage. This contributes to low survivability due to this cancer. CRC patients present various genetic changes and epigenetic modifications. The most common genetic alterations associated with CRC are p53 and KRAS mutations. Gene therapy targeting defect genes such as TP53 (tumor suppressor gene encodes for p53) and KRAS (oncogene) in CRC potentially serves as an alternative treatment avenue for the disease in addition to the standard therapy. For the last decade, significant developments have been seen in gene therapy for translational purposes in treating various cancers. This includes the development of vectors as delivery vehicles. Despite the optimism revolving around targeted gene therapy for cancer treatment, it also has various limitations, such as a lack of availability of related technology, high cost of the involved procedures, and ethical issues. This article will provide a review on the potentials and challenges of gene therapy targeting p53 and KRAS for the treatment of CRC.

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Cost-Effectiveness of RAS Genetic Testing Strategies in Patients With Metastatic Colorectal Cancer: A Systematic Review

Cited by 12 publications

References 41 publications

Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients

Economic Impact of the Application of a Precision Medicine Model (5SPM) on Psychotic Patients

Sociodemographic and clinical factors associated with receipt of biomarker testing in patients with metastatic colorectal cancer

Gene Therapy Targeting p53 and KRAS for Colorectal Cancer Treatment: A Myth or the Way Forward?

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