A cost-effectiveness framework to evaluate a predictive companion diagnostics of selecting men with high risk localized prostate cancer for neoadjuvant or adjuvant chemotherapy in the u.s.
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He, Jimmy.
A cost-effectiveness framework to evaluate a predictive companion diagnostics of selecting men with high risk localized prostate cancer for neoadjuvant or adjuvant chemotherapy in the u.s. Retrieved from
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TitleA cost-effectiveness framework to evaluate a predictive companion diagnostics of selecting men with high risk localized prostate cancer for neoadjuvant or adjuvant chemotherapy in the u.s.
Date Created2015
Other Date2015-05 (degree)
Extent1 online resource (xi, 139 p. : ill.)
DescriptionPatients with high-risk localized prostate cancer (HRLPC) are difficult to manage. They are at high risk of recurrence, metastasis, or even early death. The standard of care (SOC) has been the same for many years. Chemotherapy is being actively tested in clinical trials for HRLPC patients. Since chemotherapy is associated with cytotoxicity, a treatment strategy with companion diagnostics (CDX) is needed to choose chemo respondents. The objective of this study is to build a cost-effectiveness framework to analyze the economic value of CDX to select HRLPC patients for chemotherapy. An area under the curve cost-effectiveness model, which considers three treatment strategies, i.e., treating all patients with SOC, treating all patients with chemo, or selectively treating with chemotherapy with assistance of a CDX (personalized medicine), was constructed. Data inputs were drawn primarily from a database analysis based on the Surveillance Epidemiology and End Results (SEER)-Medicare Database in conjunction with secondary data based on literature reviews. Overall, 24,094 HRLPC patients receiving active treatments between 1990 and 2011 were identified. Metastasis-free survival, overall survival, and cost patterns were analyzed for the entire cohort as well as subgroups. Cost-effectiveness measures including incremental cost-effectiveness ratios were calculated. Both one-way sensitivity analysis and probabilistic sensitivity analysis were conducted to understand the effect of data inputs on cost-effectiveness results. If a generic chemotherapy provided meaningful clinical benefits and was administrated for only 6-month treatment, and if the companion diagnostics test was given free of charge, it was cost-effective to treat HRLPC patients using both strategies, including treating all with chemotherapy and personalized medicine versus SOC. The personalized treatment strategy was the most cost-effective choice. The result was highly sensitive to treatment duration, effectiveness, treatment costs, as well as assumptions of CDX (prevalence, sensitivity, and specificity). A diagnostic manufacturer could charge a reasonable price for the companion diagnostics test consistent with current pricing practice. This study provides an analytical tool to understand the economic value of an effective treatment and its companion diagnostics. Various simulations indicated that personalized treatment strategy is always preferred. The model can be extended to analyze the value of CDX in broader cancer diseases settings.
NotePh.D.
NoteIncludes bibliographical references
Noteby Jimmy He
Genretheses, ETD doctoral
Languageeng
CollectionGraduate School - New Brunswick Electronic Theses and Dissertations
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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