1. Cost-effectiveness analysis of tumor molecular classification in high-risk early-stage endometrial cancer.
- Author
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Orellana, T.J., Kim, H., Beriwal, S., Bhargava, R., Berger, J., Buckanovich, R.J., Coffman, L.G., Courtney-Brooks, M., Mahdi, H., Olawaiye, A.B., Sukumvanich, P., Taylor, S.E., Smith, K.J., and Lesnock, J.L.
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TUMOR classification , *ENDOMETRIAL cancer , *COST effectiveness , *QUALITY-adjusted life years , *DIRECT costing , *HEREDITARY nonpolyposis colorectal cancer , *ENDOMETRIAL tumors - Abstract
Tumor molecular analyses in endometrial cancer (EC) includes 4 distinct subtypes: (1) POLE -mutated, (2) mismatch repair protein (MMR) deficient, (3) p53 mutant, and (4) no specific molecular profile. Recently, a sub-analysis of PORTEC-3 demonstrated notable differences in treatment response between molecular classification (MC) groups. Cost of testing is one barrier to widespread adoption of MC. Therefore, we sought to determine the cost-effectiveness of MC in patients with stage I and II high-risk EC. A Markov decision model was developed to compare tumor molecular classification (TMC) vs. no testing (NT). A healthcare payor's perspective and 5-year time horizon were used. Base case data were abstracted from PORTEC-3 and the molecular sub-analysis. Cost and utility data were derived from public databases, peer-reviewed literature, and expert input. Strategies were compared using the incremental cost-effectiveness ratio (ICER) with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Sensitivity analyses were performed to test model robustness. When compared to NT, TMC was cost effective with an ICER of $25,578 per QALY gained; incremental cost was $1780 and incremental effectiveness was 0.070 QALYs. In one-way sensitivity analyses, results were most sensitive to the cost of POLE testing, but TMC remained cost-effective over all parameter ranges. TMC in early-stage high-risk EC is cost-effective, and the model results were robust over a range of parameters. Given that MC can be used to guide adjuvant treatment decisions, these findings support adoption of TMC into routine practice. • Tumor molecular testing is a rapidly emerging area of research in endometrial cancer and may guide adjuvant treatment. • A Markov decision model was developed to compare tumor molecular classification versus no molecular testing. • Compared to no testing, tumor molecular classification is a highly cost-effective strategy. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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