Molecular biomarkers and precision medicine in colorectal cancer: a systematic review of health economic analyses

Raymond Henderson, Declan French, Mark Lawler, Michael Clarke, Richard Sullivan, Tim Maughan

Research output: Contribution to conferencePoster

Abstract

Introduction: Identification of biomarkers in colorectal cancer (CRC) drives the on-going application of stratified precision medicine to quality care. Though scientific evidence has underpinned clinical adoption of biomarkers to guide therapy, cost-effectiveness analysis (CEA) has not been systematically applied to support their health system incorporation.
Methods: We conducted a systematic review of health economic assessments of molecular biomarkers and their employment in patient stratification in CRC. Articles were identified by systematic literature search if they were published between 1 January 2006 and 31 December 2015. We searched MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web of Science, Econlit and SCHARR. Articles were screened for eligibility based on PICOS (Population, Intervention, Comparator, Outcome, and Study design). Life years gained (LYGs), quality-adjusted life years (QALYs), and incremental cost-effective ratios (ICERs) were extracted from each article. Articles were rated according consolidated health economic evaluations reporting standards (CHEERS).
Result: Our analysis supports Oncotype Dx as a cost-effective test in high income settings to limit treatment toxicity in CRC patients. Dihydropyrimidine dehydrogenase gene (DYPD) status testing may also be cost effective in certain settings to avoid specific 5-Fluouracil (5-FU) toxicities post treatment. In contrast, cost effectiveness analysis did not support uridine 5′‐diphospho‐ glucuronosyltransferase family 1 member A1 gene (UGT1A1) polymorphism status to help guide irinotecan dosing, while the health economic evidence to support RAS mutational status and Epidermal Growth Factor Receptor (EGFR) therapy was inconclusive, despite the widespread adoption of this molecular biomarker to guide a precision medicine therapeutic intervention.

Discussion: Our data highlight the paucity of quality CEA studies to support the clinical application of precision medicine approaches in CRC and argue for robust prospectively designed health economic analyses to help guide value-based care for CRC patients.
Original languageEnglish
Publication statusPublished - 27 Nov 2017
EventEuropean Alliance for Personalised Medicine Conference : “Personalising your Health: A Global Imperative” - Belfast, United Kingdom
Duration: 25 Nov 201729 Nov 2017

Conference

ConferenceEuropean Alliance for Personalised Medicine Conference
CountryUnited Kingdom
CityBelfast
Period25/11/201729/11/2017

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