Is There Large Underused Potential in Using Genetic Tests to Better Stratify Patients to Established Therapies?
Author(s)
Discussion Leader: Maureen Rutten-van Mölken, PhD, Erasmus School of Health Policy and Management (ESHPM) / Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, ZH, Netherlands
Discussants: Balázs Nagy, PhD, Economic Modelling Division, Syreon Research Institute, Budapest, PE, Hungary; Rositsa Koleva-Kolarova, PhD, Health Economics Research Centre, University of Oxford, Oxford, OXF, UK; Heleen Vellekoop, MSc, Erasmus University Rotterdam, institute for Medical Technology Assessment, Rotterdam, Netherlands
PURPOSE: Opportunities to personalize medicine based on molecular genetic tests are rapidly evolving. The cost-effectiveness of a test-treatment pathway may highly depend on the testing-strategy chosen. The optimal strategy can vary by country, depending among others on the infrastructure for genetic testing, and local pricing and reimbursement. In our earlier literature review, the added value of genetic testing seemed higher when patients were stratified to existing rather than new therapies. To further investigate this, we aim to compare the cost-effectiveness and budget-impact of three case studies of different genetic testing strategies in the England, Hungary, and the Netherlands.
DESCRIPTION:
The three case studies differ by type and purpose of the genetic tests. In the first case, different testing strategies for NTRK gene fusions (varying combinations of immunohistochemistry tests and next-generation sequencing panels of tumour RNA) are used to identify patients likely to respond to the new histology-independent treatment entrectinib. In the second case, the ToxNav© DNA test is used to identify breast cancer patients with DPYD gene mutations leading to an increased risk of severe toxicity from common fluoropyrimidine-based chemotherapies. In the third case, different testing strategies (varying combinations of a survey, an auto-antibody test, and a DNA test) are used to identify patients mistakenly diagnosed as type-1 diabetes patients, while they have Maturity-Onset Diabetes of the Young and respond poorly to insulin. Cost-effectiveness outcomes for the latter two cases (where patients are stratified to existing treatments) were much more favorable than in the former (patients are stratified to a new treatment). This lends support for the findings from our earlier review study. Interaction with the audience: Real-time polling will invite comments and guide discussion on the added value of genetic testing for stratification to existing versus new therapies and potential differences in optimal testing strategies between countries with different income levels.Conference/Value in Health Info
Code
144
Topic
Economic Evaluation