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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.
Descriptive
TitleInfo
Title
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.
Name
(type = personal)
NamePart
(type = family)
He
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(type = given)
Jimmy
NamePart
(type = date)
1967-
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Jimmy He
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(authority = RULIB)
author
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(type = personal)
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Lu-Yao
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Grace
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Grace Lu-Yao
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Advisory Committee
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chair
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DEMISSIE
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KITAW
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KITAW DEMISSIE
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Advisory Committee
Role
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(authority = RULIB)
internal member
Name
(type = personal)
NamePart
(type = family)
Moore
NamePart
(type = given)
Dirk
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Dirk Moore
Affiliation
Advisory Committee
Role
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(authority = RULIB)
internal member
Name
(type = personal)
NamePart
(type = family)
Yamada
NamePart
(type = given)
Tetsuji
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Tetsuji Yamada
Affiliation
Advisory Committee
Role
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(authority = RULIB)
outside member
Name
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NamePart
Rutgers University
Role
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(authority = RULIB)
degree grantor
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NamePart
Graduate School - New Brunswick
Role
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(authority = RULIB)
school
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Text
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(authority = marcgt)
theses
OriginInfo
DateCreated
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2015
DateOther
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2015-05
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2015
Place
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xx
Language
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(type = code)
eng
Abstract
(type = abstract)
Patients 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.
Subject
(authority = RUETD)
Topic
Public Health
Subject
(authority = ETD-LCSH)
Topic
Prostate--Cancer--Treatment
Subject
(authority = ETD-LCSH)
Topic
Chemotherapy
Subject
(authority = ETD-LCSH)
Topic
Cost effectiveness
RelatedItem
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TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
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ETD
Identifier
ETD_6278
PhysicalDescription
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electronic resource
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application/pdf
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text/xml
Extent
1 online resource (xi, 139 p. : ill.)
Note
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Ph.D.
Note
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Includes bibliographical references
Note
(type = statement of responsibility)
by Jimmy He
RelatedItem
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TitleInfo
Title
Graduate School - New Brunswick Electronic Theses and Dissertations
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rucore19991600001
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NjNbRU
Identifier
(type = doi)
doi:10.7282/T34J0GZ6
Genre
(authority = ExL-Esploro)
ETD doctoral
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Rights
RightsDeclaration
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The author owns the copyright to this work.
RightsHolder
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Name
FamilyName
He
GivenName
Jimmy
Role
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RightsEvent
Type
Permission or license
DateTime
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2015-04-08 11:29:59
AssociatedEntity
Name
jimmy He
Role
Copyright holder
Affiliation
Rutgers University. Graduate School - New Brunswick
AssociatedObject
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
RightsEvent
DateTime
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(qualifier = exact);
(point = start)
2015-05-31
DateTime
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2017-05-30
Type
Embargo
Detail
Access to this PDF has been restricted at the author's request. It will be publicly available after May 30th, 2017.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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Technical
RULTechMD
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ContentModel
ETD
OperatingSystem
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windows xp
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