Molecular biomarkers and precision medicine in colorectal cancer: Value for Money?

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

Research output: Contribution to conferencePoster


An increased understanding of the biology of colorectal cancer (CRC) has fuelled identification of biomarkers with potential to drive a stratified precision medicine approach in this common malignancy. While scientific evidence has underpinned clinical adoption of certain biomarkers to guide therapeutic intervention, the cost effectiveness evidence to support their incorporation into health systems is less compelling. We conducted a systematic review of health economic assessments of molecular biomarkers (MBMs) and their employment in patient stratification in CRC. Our analysis revealed scenarios where health economic analyses have been applied to evaluate the cost effectiveness of MBM-guided clinical interventions: (i)evaluation of Dihydropyrimidine dehydrogenase gene (DYPD) status to identify patients susceptible to 5-Fluouracil toxicity; (ii)determination of Uridine 5′‐diphospho‐ glucuronosyltransferase family 1 member A1 gene (UGT1A1) polymorphism status to help guide irinotecan treatment; (iii)assessment of RAS/RAF mutational status to stratify patients for chemotherapy or Epidermal Growth Factor Receptor (EGFR) therapy and (iv)multigene expression analysis (Oncotype Dx) to identify and spare non-responders the debilitating effects of particular chemotherapy interventions.
Our findings indicate that Oncotype Dx is cost-effective in high income settings within specific price points, by limiting treatment toxicity in CRC patients. DYPD status testing may also be cost effective in certain settings to avoid specific 5-FU toxicities post treatment. In contrast, current research does not support UGT1A1 polymorphism status as a cost-effective guide to irinotecan dosing, while the health economic evidence to support testing of KRAS/NRAS mutational status and chemo/EGFR therapy choice was inconclusive, despite its widespread adoption in CRC treatment management. Our analysis indicates that there is a paucity of high quality cost-effectiveness studies to support clinical application of precision medicine approaches in CRC. More robust, prospectively designed health economic analyses to help guide value-based care for CRC patients are urgently needed.
Original languageEnglish
Publication statusPublished - 12 Sep 2018
EventTMED9 Conference: Innovating to Live Well for Longer - City Hotel, Derry, United Kingdom
Duration: 12 Sep 201812 Sep 2018


ConferenceTMED9 Conference
Country/TerritoryUnited Kingdom
Internet address


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