Cost effectiveness of the Decipher genomic classifier to guide individualized decisions for early radiation therapy after prostatectomy for prostate cancer

• Published in: Clinical genitourinary cancer 2017-06, Vol.15 (3), p.e299-e309
• Main Authors: Lobo, Jennifer M., PhD, Trifiletti, Daniel M., MD, Sturz, Vanessa N., MS, Dicker, Adam P., MD, PhD, Buerki, Christine, PhD, Davicioni, Elai, PhD, Cooperberg, Matthew R, Karnes, R. Jeffrey, MD, Jenkins, Robert B., MD, Den, Robert B., MD, Showalter, Timothy N., MD, MPH
• Format: Article
• Language: English
• Subjects: Adjuvant and salvage radiation therapy; Clinical Decision-Making; Cost-Benefit Analysis; Cost-effectiveness analysis; Disease Progression; Genomics - economics; Hematology, Oncology and Palliative Medicine; Humans; Individualized medicine; Male; Markov Chains; Molecular assay; Precision Medicine; Prostatectomy; Prostatic neoplasms; Prostatic Neoplasms - genetics; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Quality-Adjusted Life Years; Urology
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2016.08.012

Abstract Purpose There is controversy regarding the effectiveness of early adjuvant versus salvage radiation therapy after prostatectomy for prostate cancer. Estimates of prostate cancer progression from the Decipher® genomic classifier (GC) may guide informed decision-making and improve outcomes for patients. Patients and Methods We developed a Markov model to compare costs and quality-adjusted life years (QALYs) associated with GC-based treatment decisions regarding adjuvant therapy after prostatectomy to two control strategies: usual care(UC) (based on patterns of care studies) and the alternative of 100% adjuvant radiation therapy. Using the bootstrapping method of sampling with replacement, 10,000 patients were simulated over a 10-year time horizon with each subject having individual estimates for cancer progression (based on GC) and non-cancer mortality (based on age). Results GC-based care was more effective and less costly than 100% adjuvant radiation therapy utilization, and was cost saving up to an assay cost of $11,402. Compared to UC, GC-based care resulted in more QALYs. Assuming a $4000 assay cost, the incremental cost-effectiveness ratio was $90,833 per QALY, assuming a 7% utilization rate of adjuvant radiation therapy. GC-based care was also associated with a 16% reduction in the percentage of patients with distant metastasis at 5 years compared to UC. Conclusion The Decipher GC may be a cost-effective approach for genomics-driven cancer treatment decisions after prostatectomy, with improvements in estimated clinical outcomes compared to UC. The individualized decision analytic framework applied in this study offers a flexible approach to estimate the potential utility of genomic assays for personalized cancer medicine.