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

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.

The Clinical Significance of Occult Gastrointestinal Primary Tumours in Metastatic Cancer: A Population Retrospective Cohort Study

“…Our case definition is consistent with other attempts at identifying occult primary tumours [ 20 ]. Full details regarding the identification of our metastatic patient population are reported elsewhere [ 21 ].…”

“…We linked those patients with the Provincial Pharmacy Program of CCMB and Manitoba Health’s administrative databases to validate all cancer therapy data captured by the MCR; to collect additional information on types of radiotherapy, chemotherapy, and targeted cancer therapy agents as described elsewhere [ 16 - 19 ]; and to measure co-morbidity using the method developed by Charlson et al [ 22 ] and used elsewhere [ 18 , 19 , 21 ]. We also used, in particular, the Physician Claims Database to collect information on GI diagnostic examinations received during the diagnostic workup (defined as the period from 6 months before to 6 months after cancer diagnosis) for all identified patients diagnosed with metastatic cancer of GI sites.…”

The Potential Clinical and Economic Value of Primary Tumour Identification in Metastatic Cancer of Unknown Primary Tumour: A Population-Based Retrospective Matched Cohort Study

“…We have previously used the MCR to identify a cohort of patients diagnosed initially with metastatic cancer during the period from 1 January 2002 to 31 December 2011 [ 34 ] and identify when these patients had their primary tumour diagnosed during the course of their disease. The cohort was limited to Manitoba residents who had undergone clinical and pathological diagnostic evaluation in Manitoba and with no history of other malignancy at initial diagnosis.…”

“…surgical and therapeutic radiology procedures, systemic therapy and palliative care) and death. Full details regarding the identification of this metastatic patient population and the process by which we identified when primary tumours were diagnosed are reported elsewhere [ 34 ].…”

The Clinical Significance of Occult Gynecologic Primary Tumours in Metastatic Cancer

“…This 6-month window for the definition of an occult primary tumour is considered conservative compared with other attempts to identify occult primary tumours using only a 2-month window 5 . Full details about the identification of occult primary tumours in our metastatic patient population are also reported elsewhere 19,20 .…”