COST-EFFECTIVENESS OF PRE-TREATMENT COMPREHENSIVE GENOMIC PROFILING IN ADVANCED COLORECTAL CANCER: A JAPANESE PAYER PERSPECTIVE
Author(s)
Ataru Igarashi, PhD1, Ayako Shoji, PhD2, Shizuko Suzuki, MS3.
1Associate professor, Faculty of Pharmacy, Tokyo University, Tokyo, Japan, 2University of Tokyo, Bunkyo-ku, Japan, 3Illumina KK, Tokyo, Japan.
1Associate professor, Faculty of Pharmacy, Tokyo University, Tokyo, Japan, 2University of Tokyo, Bunkyo-ku, Japan, 3Illumina KK, Tokyo, Japan.
OBJECTIVES: To assess the cost-effectiveness of comprehensive genomic profiling (CGP) performed prior to first-line therapy versus after standard treatment in patients with unresectable advanced or recurrent Colorectal Cancer (CRC) in Japan.
METHODS: A hybrid decision-tree and partitioned survival model was developed from the Japanese public healthcare payer perspective. The intervention was pre-treatment CGP; the comparator was individual genetic test (BRAF/KRAS, MSI, HER2) followed by post-progression CGP, reflecting current clinical practice. Six mutation-directed regimens (MSI, BRAF, KRAS, RET, NTRK, HER2) for wild-type patients were modelled per the Japanese Colorectal Cancer Guidelines 2024. Test costs were JPY 560,000 (CGP) and JPY 25000 to 50000 (individual test ). Utilities were 0.768 (progression-free) and 0.632 (progressed). Costs and QALYs were discounted at 2% annually with a one-month cycle. Deterministic and probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to JPY 5.0 million to 7.5 million/QALY.
RESULTS: Pre-treatment CGP yielded 2.3681 QALYs at JPY 12,614,706, versus 2.3645 QALYs at JPY 11,442,458 with post-treatment CGP. Incremental cost and effectiveness were JPY 1,172,247 and 0.0036 QALYs, respectively, producing an ICER of JPY 324,101,244/QALY (~USD 2,000,000/QALY)—far above to oncology threshold. Throughout various sensitivity analyses, the ICER remained far above JPY 15 million/QALY across all plausible scenarios, and reductions in CGP unit cost alone did not yield cost-effectiveness.
CONCLUSIONS: Pre-treatment CGP confers a little QALY gains but is unlikely to be cost-effective under current Japanese treatment environment. Its economic value is determined less by the test itself than by the price and efficacy of downstream targeted therapies and ICIs. Given that their extremely high ICER value compared to other disease area, CGP in the CRC area should be appraised within the broader precision-oncology ecosystem rather than as a standalone diagnostic.
METHODS: A hybrid decision-tree and partitioned survival model was developed from the Japanese public healthcare payer perspective. The intervention was pre-treatment CGP; the comparator was individual genetic test (BRAF/KRAS, MSI, HER2) followed by post-progression CGP, reflecting current clinical practice. Six mutation-directed regimens (MSI, BRAF, KRAS, RET, NTRK, HER2) for wild-type patients were modelled per the Japanese Colorectal Cancer Guidelines 2024. Test costs were JPY 560,000 (CGP) and JPY 25000 to 50000 (individual test ). Utilities were 0.768 (progression-free) and 0.632 (progressed). Costs and QALYs were discounted at 2% annually with a one-month cycle. Deterministic and probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to JPY 5.0 million to 7.5 million/QALY.
RESULTS: Pre-treatment CGP yielded 2.3681 QALYs at JPY 12,614,706, versus 2.3645 QALYs at JPY 11,442,458 with post-treatment CGP. Incremental cost and effectiveness were JPY 1,172,247 and 0.0036 QALYs, respectively, producing an ICER of JPY 324,101,244/QALY (~USD 2,000,000/QALY)—far above to oncology threshold. Throughout various sensitivity analyses, the ICER remained far above JPY 15 million/QALY across all plausible scenarios, and reductions in CGP unit cost alone did not yield cost-effectiveness.
CONCLUSIONS: Pre-treatment CGP confers a little QALY gains but is unlikely to be cost-effective under current Japanese treatment environment. Its economic value is determined less by the test itself than by the price and efficacy of downstream targeted therapies and ICIs. Given that their extremely high ICER value compared to other disease area, CGP in the CRC area should be appraised within the broader precision-oncology ecosystem rather than as a standalone diagnostic.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE69
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Disease
Oncology