| Title |
Assessing cost-utility of predictive biomarkers in oncology: a streamlined approach
|
|---|---|
| Published in |
Breast Cancer Research and Treatment, January 2016
|
| DOI | 10.1007/s10549-016-3677-3 |
| Pubmed ID | |
| Authors |
Anton Safonov, Shiyi Wang, Cary P. Gross, Divyansh Agarwal, Giampaolo Bianchini, Lajos Pusztai, Christos Hatzis |
| Abstract |
Evaluation of cost-utility is critical in assessing the medical utility of predictive or prognostic biomarkers. Current methods involve complex state-transition models, requiring comprehensive data inputs. We propose a simplified decision-analytic tool to explore the relative effect of factors contributing to the cost-utility of a biomarker. We derived a cost-utility metric, the "test incremental cost-effectiveness ratio" (TICER) for biomarker-guided treatment compared to no biomarker use. This method uses data inputs readily accessible through clinical literature. We compared our results with traditional cost-effectiveness analysis of predictive biomarkers for established (HER2-guided trastuzumab, ALK-guided crizotinib, OncotypeDX-guided adjuvant chemotherapy) and emerging (ROS1-guided crizotinib) targeted treatments. We conducted sensitivity analysis to determine which factors had the greatest impact on TICER estimates. Base case TICER for HER2 was $149,600/quality-adjusted life year (QALY), for ALK was $22,200/QALY, and for OncotypeDX was $11,600/QALY, consistent with literature-reported estimates ($180,000/QALY, $202,800/QALY, $8900/QALY, respectively). Base case TICER for ROS1-guided crizotinib was $205,900/QALY. Generally, when treatment cost is considerably greater than biomarker testing costs, TICER is driven by clinical outcomes and health-related quality of life, while biomarker prevalence and treatment cost have a lesser effect. Our simplified decision-analytic approach produces values consistent with existing cost-effectiveness analyses. Our results suggest that biomarker value is mostly driven by the clinical efficacy of the targeted agent. A user-friendly web tool for complete TICER analysis has been made available for open use at http://medicine.yale.edu/lab/pusztai/ticer/ . |
X Demographics
The data shown below were collected from the profiles of 5 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 3 | 60% |
| United States | 1 | 20% |
| Unknown | 1 | 20% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 3 | 60% |
| Scientists | 1 | 20% |
| Practitioners (doctors, other healthcare professionals) | 1 | 20% |
Mendeley readers
The data shown below were compiled from readership statistics for 60 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 1 | 2% |
| Unknown | 59 | 98% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 14 | 23% |
| Student > Master | 7 | 12% |
| Unspecified | 5 | 8% |
| Student > Bachelor | 5 | 8% |
| Student > Postgraduate | 4 | 7% |
| Other | 11 | 18% |
| Unknown | 14 | 23% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 18 | 30% |
| Unspecified | 5 | 8% |
| Pharmacology, Toxicology and Pharmaceutical Science | 4 | 7% |
| Agricultural and Biological Sciences | 3 | 5% |
| Nursing and Health Professions | 3 | 5% |
| Other | 9 | 15% |
| Unknown | 18 | 30% |
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 February 2016.
All research outputs
#7,470,187
of 22,837,982 outputs
Outputs from Breast Cancer Research and Treatment
#1,657
of 4,660 outputs
Outputs of similar age
#123,704
of 393,971 outputs
Outputs of similar age from Breast Cancer Research and Treatment
#14
of 57 outputs
Altmetric has tracked 22,837,982 research outputs across all sources so far. This one is in the 44th percentile – i.e., 44% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,660 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 7.2. This one is in the 41st percentile – i.e., 41% of its peers scored the same or lower than it.
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We're also able to compare this research output to 57 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 71% of its contemporaries.