Model-based effectiveness and cost-effectiveness of risk-based selection strategies for adjuvant chemotherapy in Dutch stage II colon cancer patients

Jongeneel, Gabrielle; Greuter, Marjolein J.E.; Erning, Felice N. van; Koopman, Miriam; Vink, Geraldine R.; Punt, Cornelis J.A.; Coupé, Veerle M.H.

doi:10.1177/1756284821995715

Cited by 6 publications

(4 citation statements)

References 36 publications

(57 reference statements)

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“…Jongeneel et al compared several AC selection strategies in stage II cancers that were T4, and MSS tumours utilising a biomarker approach based on the presence of BRAF and KRAS mutations [ 51 ]. The study concluded that AC prescription based on molecular biomarkers (4.8%) dominates no patients receiving AC.…”

Section: Resultsmentioning

confidence: 99%

“…Notably, three of the included studies utilised such registries in modelling transitions between health states such as disease free to recurrence or death. Two studies utilised the Netherlands Cancer Registry (NCR) to develop a health model that simulates patients with stage II colon cancer from diagnosis to death [ 4 , 51 ]. The third study utilised an Australian-based multi-site colorectal cancer registry (ACCORD) to model the progression of patients following recurrence to death [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review

Gibbs

Tie

et al. 2023

Cost Eff Resour Alloc

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Objective The aims of this study was to appraise the health economic evidence for adjuvant chemotherapy (AC) strategies in stage II and III colon cancer (CC) and identify gaps in the available evidence that might inform further research. Method A systematic review of published economic evaluations was undertaken. Four databases were searched and full-text publications in English were screened for inclusion. A narrative synthesis was performed to summarise the evidence. Results Thirty-eight studies were identified and stratified by cancer stage and AC strategy. The majority (89%) were full economic evaluations considering both health outcomes, usually measured as quality-adjusted life years (QALYs), and costs. AC was found to be cost-effective compared to no AC for both stage II and III CC. Oral and oxaliplatin-based AC was cost-effective for stage III. Three months of CAPOX was cost-effective compared to 6-month in high-risk stage II and stage III CC. Preliminary evidence suggests that biomarker approaches to AC selection in stage II can reduce costs and improve health outcomes. Notably, assessment of QALYs were predominantly reliant on a small number of non-contemporary health-utility studies. Only 32% of studies considered societal costs such as travel and time off work. Conclusions Published economic evaluations consistently supported the use of AC in stage II and III colon cancer. Biomarker-driven approaches to patient selection have great potential to be cost-effective, but more robust clinical and economic evidence is warranted. Patient surveys embedded into clinical trials may address critical knowledge gaps regarding accurate assessment of QALYs and societal costs in the modern era.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review

Gibbs

Tie

et al. 2023

Cost Eff Resour Alloc

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“…50 Jongeneel et al compared several AC selection strategies in stage II cancers that were T4, and MSS tumours utilising a biomarker approach based on the presence of BRAF and KRAS mutations. 51 The study concluded that AC prescription based on molecular biomarkers (4.8%) dominates no patients receiving AC. Patients in this model could have received either 3-months of CAPOX or 6-months of 5FU or FOLFOX, with the biomarker strategy retaining cost-effectiveness in scenarios in which only capecitabinebased AC was prescribed.…”

Section: Oxaliplatin-based Acmentioning

confidence: 98%

Health economic evidence for adjuvant chemotherapy in stage II and III colorectal cancer: a systematic review

Gibbs

Tie

et al. 2022

Preprint

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Objective: The aims of this study was to appraise the health economic evidence for adjuvant chemotherapy (AC) strategies in stage II and III colorectal cancer (CRC) and to identify gaps in the available evidence that might inform further research.Method : A systematic review of published economic evaluations was undertaken. Four databases were searched and full-text publications in English were screened for inclusion. A narrative synthesis was performed to summarise the evidence.Results: Thirty-eight studies were identified and stratified by cancer stage and AC strategy. The majority (89%) were full economic evaluations considering both health outcomes, usually measured as quality-adjusted life years (QALYs), and costs. AC was found to be cost-effective compared to no AC for both stage II and III CRC. Oral and oxaliplatin-based AC was cost-effective for stage III. Three months of CAPOX was cost-effective compared to 6-month in high-risk stage II and stage III CRC. Preliminary evidence suggests that biomarker approaches to AC selection in stage II can reduce costs and improve health outcomes. Notably, assessment of QALYs were predominantly reliant on a small number of non-contemporary health-utility studies. Only 32% of studies considered societal costs such as travel and time off work. Conclusions: Published economic evaluations consistently supported the use of AC in stage II and III colorectal cancer. Biomarker-driven approaches to patient selection have great potential to be cost-effective, but more robust clinical and economic evidence is warranted. Patient surveys embedded into clinical trials may address critical knowledge gaps regarding accurate assessment of QALYs and societal costs in the modern era.

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“…In a recent model-based cost-effectiveness study, we showed that adding BRAF and/or KRAS mutation status as a selection criterion for adjuvant chemotherapy in stage II colon cancer can potentially improve patients' survival (9). In addition to BRAF and KRAS mutation status, the prognostic value of a large number of other molecular markers in the stage II colon cancer population has been demonstrated (5,8).…”

Section: Introductionmentioning

confidence: 99%

Early Cost-effectiveness Analysis of Risk-Based Selection Strategies for Adjuvant Treatment in Stage II Colon Cancer: The Potential Value of Prognostic Molecular Markers

Jongeneel

Greuter

Kunst

et al. 2021

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: To explore the potential value of consensus molecular subtypes (CMS) in stage II colon cancer treatment selection, we carried out an early cost-effectiveness assessment of a CMS-based strategy for adjuvant chemotherapy. Methods: We used a Markov cohort model to evaluate three selection strategies: (i) the Dutch guideline strategy (MSS+pT4), (ii) the mutation-based strategy (MSS plus a BRAF and/or KRAS mutation or MSS plus pT4), and (iii) the CMS-based strategy (CMS4 or pT4). Outcomes were number of colon cancer deaths per 1,000 patients, total discounted costs per patient (pp), and quality-adjusted life-years (QALY) pp. The analyses were conducted from a Dutch societal perspective. The robustness of model predictions was assessed in sensitivity analyses. To evaluate the value of future research, we performed a value of information (VOI) analysis. Results: The Dutch guideline strategy resulted in 8.10 QALYs pp and total costs of €23,660 pp. The CMS-based and mutation-based strategies were more effective and more costly, with 8.12 and 8.13 QALYs pp and €24,643 and €24,542 pp, respectively. Assuming a threshold of €50,000/QALY, the mutation-based strategy was considered as the optimal strategy in an incremental analysis. However, the VOI analysis showed substantial decision uncertainty driven by the molecular markers (expected value of partial perfect information: €18M). Conclusions: On the basis of current evidence, our analyses suggest that the mutation-based selection strategy would be the best use of resources. However, the extensive decision uncertainty for the molecular markers does not allow selection of an optimal strategy at present. Impact: Future research is needed to eliminate decision uncertainty driven by molecular markers.

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Model-based effectiveness and cost-effectiveness of risk-based selection strategies for adjuvant chemotherapy in Dutch stage II colon cancer patients

Cited by 6 publications

References 36 publications

Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review

Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review

Health economic evidence for adjuvant chemotherapy in stage II and III colorectal cancer: a systematic review

Early Cost-effectiveness Analysis of Risk-Based Selection Strategies for Adjuvant Treatment in Stage II Colon Cancer: The Potential Value of Prognostic Molecular Markers

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