Abstract

Objectives

Gene-expression profiling (GEP) reliably supplements traditional clinicopathological information on the tissue of origin (TOO) in metastatic or poorly differentiated cancer. A cost-effectiveness analysis of GEP TOO testing versus usual care was conducted from a US third-party payer perspective.

Methods

Data on recommendation changes for chemotherapy, surgery, radiation therapy, blood tests, imaging investigations, and hospice care were obtained from a retrospective, observational study of patients whose physicians received GEP TOO test results. The effects of chemotherapy recommendation changes on survival were based on the results of trials cited in National Comprehensive Cancer Network and UpToDate guidelines. Drug and administration costs were based on average doses reported in National Comprehensive Cancer Network guidelines. Other unit costs came from Centers for Medicare probabilistic sensitivity analysis addressed parameter uncertainty.

Results

Chemotherapy regimen recommendations consistent with guidelines for final tumor-site diagnoses increased significantly from 42% to 65% (net difference 23%; P two-sided 95% confidence interval [CI] 3.2–3.9). The average increase in quality-adjusted life-months was 2.7 months (95% CI 1.5–4.3), and average third-party payer costs per patient increased by $10,360 (95% CI $2,982–$19,192). The cost per quality-adjusted life-year gained was $46,858 (95% CI $13,351–$104,269).

Conclusions

GEP TOO testing significantly altered clinical practice patterns and is projected to increase overall survival, quality-adjusted life-years, and costs, resulting in an expected cost per quality-adjusted life-year of less than $50,000.