Journal of Cancer Policy最新文献

{"title":"Shaping the future research agenda of Cancer Nursing in Italy: Insights and strategic directions","authors":"Rosario Caruso ,&nbsp;Gianluca Conte ,&nbsp;Marco Alfredo Arcidiacono ,&nbsp;Serena Caponetti ,&nbsp;Gabriele Cremona ,&nbsp;Marcella Dabbene ,&nbsp;Monica Guberti ,&nbsp;Alessio Piredda ,&nbsp;Arianna Magon","doi":"10.1016/j.jcpo.2024.100505","DOIUrl":"10.1016/j.jcpo.2024.100505","url":null,"abstract":"<div><p>This report analyzes the evolution of cancer nursing research in Italy, focusing on 207 publications from nursing journals indexed in MEDLINE. Using Latent Dirichlet Allocation, we identified four primary research topics from the included abstracts: Patient-Centered Care, Clinical Nursing Practice, Healthcare Institutions and Systems, and Research and Data Analysis. The temporal trends reveal a shift from foundational studies on healthcare systems in the late 1990s to more recent emphases on patient-centered care and clinical practice. This progression underscores the growing importance of personalized healthcare approaches. Our findings highlight the need for continued investment in innovative nursing interventions and advanced technologies, such as telehealth, to enhance patient outcomes. Research priorities need to investigate how to tailor nursing interventions to individual patient characteristics, such as their cultural background, lifestyle, and personal values, in the area of clinical nursing practice, which is less represented in the literature thus far. The limited publications regarding clinical nursing practice in the Italian context might reflect the need to strengthen cancer nursing as a specialization in Italy to trigger research and practice that address unmet patient needs. The current analysis provides a foundation for future comprehensive studies and strategic development of a research agenda for cancer nursing research in Italy, led by the Italian Association of Cancer Nursing.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100505"},"PeriodicalIF":2.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency and non-emergency routes to cancer diagnoses in 2020 and 2021: A Population-based study of 154,863 patients","authors":"Calum Purdie ,&nbsp;Gavin R.C. Clark ,&nbsp;David A. Cameron ,&nbsp;Russell Petty ,&nbsp;Paramananthan Mariappan ,&nbsp;Janet Graham ,&nbsp;Kevin A. Burton ,&nbsp;David S. Morrison","doi":"10.1016/j.jcpo.2024.100502","DOIUrl":"10.1016/j.jcpo.2024.100502","url":null,"abstract":"<div><h3>Introduction</h3><p>The COVID-19 pandemic disrupted normal pathways to cancer diagnosis, particularly for screening and non-acute symptomatic patients. While reductions in overall cancer diagnoses have been reported elsewhere, any differential effects on emergency presentations, which are associated with poorer outcomes, have not been described.</p></div><div><h3>Material and methods</h3><p>Cross-sectional descriptive study from 2015 to 2021, based on International Cancer Benchmarking Partnership methods, where emergency route to diagnosis is defined as presenting as an emergency admission in the 30 days prior to cancer incidence date. Acute hospital records and cancer registrations were individually linked. Includes all individuals with a new diagnosis of specific cancers on the national cancer registry.</p></div><div><h3>Results</h3><p>All cancers included showed reductions in non-emergency diagnoses in 2020, with varying recovery in 2021. The largest reductions in non-emergency diagnoses of about a third were for colorectal and cervical cancers in 2020. Non-emergency diagnoses of prostate cancer remained lower but upper GI higher in 2021. Emergency routes to diagnosis were significantly higher in 2020 for breast, cervical, colorectal and upper GI cancers and were higher in 2021 for breast and cervical cancers. The absolute magnitude of reductions in non-emergency diagnoses was greater than any increases in emergency diagnoses.</p></div><div><h3>Conclusions</h3><p>In 2020, there were large reductions in numbers of cancers diagnosed through non-emergency pathways in Scotland, while those diagnosed via emergency routes fell only for prostate cancer. Some effects persisted or emerged through 2021. It is likely that opportunities to diagnose cancers in a favourable, elective manner have been lost. Further work is needed to describe outcomes among these patients.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100502"},"PeriodicalIF":2.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538324000365/pdfft?md5=7c58488cd2467325bf6e44c2aa0b4df0&pid=1-s2.0-S2213538324000365-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence and cancer: Profile of registered clinical trials","authors":"William de Oliveira Avellar ,&nbsp;Édria Aparecida Ferreira ,&nbsp;Veronica Aran","doi":"10.1016/j.jcpo.2024.100503","DOIUrl":"10.1016/j.jcpo.2024.100503","url":null,"abstract":"<div><p>Artificial Intelligence (AI) has made significant strides due to advancements in processing algorithms and data availability. Recent years have shown a resurgence in AI, driven by breakthroughs in deep machine learning. AI has attracted particular interest in the medical sector, especially in the field of personalized medicine, which for example uses large-scale genomic and molecular data to predict individual patient treatment responses. The applications of AI in disease diagnosis, monitoring, and treatment are expanding rapidly, leading to a growing number of registered trials. Therefore, this study aimed to identify and evaluate clinical trials registered between January 1st 2016, and September 30th 2023 that connect AI and cancer. Our findings show that the number of clinical trials linking AI with cancer research has grown significantly compared to other diseases, with colorectal and breast tumour types showing the highest number of registered trials. The most frequent intervention was disease diagnosis and monitoring. Regarding countries, China and the United States hold the highest numbers of registered trials. In conclusion, oncology is a field with a great interest in AI, where the developed countries are leading the studies in this field. Unfortunately, developing countries are still crawling in this aspect and government policies should be made to improve that area.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100503"},"PeriodicalIF":2.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The productivity cost of mortality due to lung cancer, breast cancer and melanoma in Europe across 2010, 2015 and 2019","authors":"Agnes Brandtmüller ,&nbsp;Anne Meiwald ,&nbsp;Edward Oliver ,&nbsp;Robert Hughes ,&nbsp;Pedro Miguel Gonzalez Capote ,&nbsp;Georgie Weston ,&nbsp;Goran Bencina","doi":"10.1016/j.jcpo.2024.100499","DOIUrl":"10.1016/j.jcpo.2024.100499","url":null,"abstract":"<div><h3>Background</h3><div>Cancer caused an estimated 2.2 million deaths across Europe in 2020. This analysis estimated the cost of lost productivity due to premature deaths associated with lung, breast and melanoma cancer and investigated the temporal trends across European regions across 2010, 2015 and 2019.</div></div><div><h3>Method</h3><div>The human capital approach was used to estimate the indirect costs from lung, melanoma, and breast cancers (ICD-10 code: C33–34, C43, and C50, respectively) in Northern, Eastern, Southern, and Western Europe. Age-specific mortality, and country-specific wages and employment rates were used to calculate years of productive life lost (YPLL), YPLL/death and present value of future lost productivity (PVFLP). Data were sourced from the World Health Organization, Eurostat, and the World Bank.</div></div><div><h3>Results</h3><div>The number of cancer deaths remained relatively stable from 2010 to 2019. YPLL/death decreased across all European regions and for all cancers between 2010 and 2019 (reported ranges across European regions; lung cancer: 25–42 %; breast cancer: 18–21 %; melanoma: 31–37 %). In Europe, the decrease in PVFLP in 2019 compared to 2010 was €2995M for lung cancer, €295M for melanoma, and €466M for breast cancer, with an overall reduction of productivity cost of €3756M in these cancer types.</div></div><div><h3>Conclusion</h3><div>The results from this study illustrate a decreased trend in productivity costs from 2010 to 2019 which could be driven by deaths occurring at an older age, suggesting that advances in cancer prevention and the treatment landscape have extended the life of cancer patients, yielding less productivity losses.</div></div><div><h3>Policy summary</h3><div>The indirect economic costs modelled show the impact of past effective health policies and new treatments. Continued efforts to improve public health policies in supporting public awareness of risk factors and value of early diagnosis could lead to further reduction in these losses. Prevention, early diagnosis, and activation of early treatment pathways could serve to reduce loss of life and improve productivity.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100499"},"PeriodicalIF":2.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scenario analysis and multi-criteria decision analysis to explore alternative reimbursement pathways for whole genome sequencing for blood cancer patients","authors":"Martin Vu ,&nbsp;Koen Degeling ,&nbsp;David Westerman ,&nbsp;Maarten J. IJzerman","doi":"10.1016/j.jcpo.2024.100501","DOIUrl":"10.1016/j.jcpo.2024.100501","url":null,"abstract":"<div><h3>Background</h3><p>Whole genome sequencing (WGS) has transformative potential for blood cancer management, but reimbursement is hindered by uncertain benefits relative to added costs. This study employed scenario planning and multi-criteria decision analysis (MCDA) to evaluate stakeholders’ preferences for alternative reimbursement pathways, informing future health technology assessment (HTA) submission of WGS in blood cancer.</p></div><div><h3>Methods</h3><p>Key factors influencing WGS reimbursement in blood cancers were identified through a literature search. Hypothetical scenarios describing various evidential characteristics of WGS for HTA were developed using the morphological approach. An online survey, incorporating MCDA weights, was designed to gather stakeholder preferences (consumers/patients, clinicians/health professionals, industry representatives, health economists, and HTA committee members) for these scenarios. The survey assessed participants' approval of WGS reimbursement for each scenario, and scenario preferences were determined using the geometric mean method, applying an algorithm to improve reliability and precision by addressing inconsistent responses.</p></div><div><h3>Results</h3><p>Nineteen participants provided complete survey responses, primarily clinicians or health professionals (n = 6; 32 %), consumers/patients and industry representatives (both at n = 5; 26 %). “Clinical impact of WGS results on patient care\" was the most critical criterion (criteria weight of 0.25), followed by \"diagnostic accuracy of WGS\" (0.21), \"cost-effectiveness of WGS\" (0.19), \"availability of reimbursed treatment after WGS\" (0.16), and \"eligibility criteria for reimbursed treatment based on actionable WGS results\" and \"cost comparison of WGS\" (both at 0.09). Participants preferred a scenario with substantial clinical evidence, high access to reimbursed targeted treatment, cost-effectiveness below $50,000 per quality-adjusted life year (QALY) gained, and affordability relative to standard molecular tests. Reimbursement was initially opposed until criteria such as equal cost to standard tests and better treatment accessibility were met.</p></div><div><h3>Conclusion</h3><p>Payers commonly emphasize acceptable cost-effectiveness, but strong clinical evidence for many variants and comparable costs to standard tests are likely to drive positive reimbursement decisions for WGS.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100501"},"PeriodicalIF":2.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538324000353/pdfft?md5=36b95bafbf28ed46ab943234879423c0&pid=1-s2.0-S2213538324000353-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Globalization of clinical research in oncology: Status, challenges, and future directions","authors":"Ana Tečić Vuger ,&nbsp;Robert Separovic ,&nbsp;Sara M. Tolaney ,&nbsp;Dario Trapani","doi":"10.1016/j.jcpo.2024.100500","DOIUrl":"10.1016/j.jcpo.2024.100500","url":null,"abstract":"<div><h3>Purpose</h3><p>Cancer is the second-leading cause of death worldwide, and its burden is increasing around the world, particularly in low- and middle-income countries (LMICs). Yet, cancer research has historically been conducted primarily in high-income countries (HICs).</p></div><div><h3>Methods</h3><p>In this review, we describe the results of our literature search into the current state of international cancer trials, including the benefits, challenges, limitations, and ethical concerns regarding the international conduct of HIC-led trials. We also propose some possible means of addressing these challenges and overcoming these barriers to extend the benefits of cancer research to people around the world.</p></div><div><h3>Results</h3><p>Over the last several decades, there has been a shift toward inclusion of investigators and participants from LMICs in pivotal cancer clinical trials.</p></div><div><h3>Conclusions</h3><p>While inclusion of LMIC countries has benefits, including increased diversity of participant populations, investment in research infrastructure in LMICs, and potential expansion of cancer treatment options around the world, the continued leadership of most trials by HICs presents ethical concerns, including potential exploitation of researchers and participants from LMICs, lack of focus on cancer types prevalent in all participating regions, and disparities in access to approved therapies once the trial is complete.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"42 ","pages":"Article 100500"},"PeriodicalIF":2.0,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking and alcohol habits in head and neck cancers: How many patients stop after diagnosis?","authors":"Barbara Verro ,&nbsp;Giuseppe Saraniti ,&nbsp;Simona Fiumara ,&nbsp;Gaetano Ottoveggio ,&nbsp;Carmelo Saraniti","doi":"10.1016/j.jcpo.2024.100498","DOIUrl":"10.1016/j.jcpo.2024.100498","url":null,"abstract":"<div><h3>Background</h3><p>Smoking and alcohol are the main risk factors for head and neck cancer. Despite the significant psychological impact, many patients continue to smoke and drink alcohol after diagnosis of cancer. This study aims to analyze the patients’ behavior post diagnosis and treatment of head and neck cancer.</p></div><div><h3>Methods</h3><p>An observational retrospective study was conducted on patients suffering from head and neck cancer. Their smoking and alcohol habits before and after diagnosis of cancer were studied.</p></div><div><h3>Results</h3><p>A total of 85 patients were recruited: 80 % males, mean age 61.77±9.30 years. Among smokers, 35.80 % continued smoking post-diagnosis. A statistically significant correlation was found between smoking habit after diagnosis of cancer and type of treatment and tracheostomy. Among drinkers, 65.52 % continued to consume alcohol after diagnosis of cancer. A statistically significant correlation was found between alcohol consumption post-diagnosis and sex.</p></div><div><h3>Conclusions</h3><p>Patients undergoing more invasive treatments are more likely to quit smoking and/or drinking alcohol, suggesting the strong psychological impact of cancer and its therapy. Many patients continue smoking and consuming alcohol due to unawareness, depression, or addiction. However, most patients reduced cigarette smoking and alcohol consumption. Comprehensive care, including psychological support, is essential for these patients.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100498"},"PeriodicalIF":2.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-sector approach to explore socio-ecological associations with treatment engagement behaviours in Northern Ghana","authors":"Chloe Tuck ,&nbsp;Laura Gray ,&nbsp;Hamza Suraj ,&nbsp;Abdul-Rashid Timtoni Iddrisu ,&nbsp;Tampuri Rahman Abane ,&nbsp;Richmond Aryeetey ,&nbsp;Braimah Abubakari Baba ,&nbsp;Robert Akparibo ,&nbsp;Richard Cooper","doi":"10.1016/j.jcpo.2024.100497","DOIUrl":"10.1016/j.jcpo.2024.100497","url":null,"abstract":"<div><h3>Background</h3><p>Cancer presents a growing global burden, not least in African countries such as Ghana where high cancer treatment dropouts has been identified due to numerous social, cultural and financial reasons. There is little understanding regarding patterns of treatment access behaviour, especially in Northern Ghana, which this study was designed to explore.</p></div><div><h3>Methods</h3><p>Through cross-sector collaboration, we extracted and clinically validated cancer patient records available in the Tamale Teaching Hospital. These were analysed descriptively and through multi-variate logistic regression. A treatment mapping process was also applied to highlight challenges in data collection. Multiple imputation with chained equations was conducted for high levels of missing data. Sensitivity analysis was applied to assess the impact of missing data.</p></div><div><h3>Results</h3><p>Treatment drop-out was high even when uncertainty due to missing data was accounted for, and only 27 % of patients completely engaged with treatment. High drop-out was found for all cancers including those covered by the Ghana National Health Insurance scheme. Multi-variate logistic regression revealed that social, health condition and systemic factors influence treatment engagement until completion. High missing data was observed for liver, ovarian, colorectal, gastric, bladder, oesophageal and head and neck and skin cancers, and soft tissue sarcomas, which limited model fitting.</p></div><div><h3>Conclusion</h3><p>Treatment drop-out is a critical issue in Northern Ghana. There was high missing data due to the dynamic, complex and decentralised treatment pathway. Future studies are needed to understand the complex challenges in data recording.</p></div><div><h3>Policy summary</h3><p>Treatment drop out is a pertinent issue that policy makers should look to address. Further discussion with stakeholders involved in cancer treatment and data collection is required to better understand challenges to routine data collection in the local setting. This will allow policy to be designed to cater for the impact of multiple intersecting health and social factors on treatment completion.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100497"},"PeriodicalIF":2.0,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538324000316/pdfft?md5=9aa42e3388642df1e933f8bb0d6d5c5a&pid=1-s2.0-S2213538324000316-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inclusivity of patients in early phase breast cancer clinical trials","authors":"A. Sinha ,&nbsp;L. Barwell ,&nbsp;H. Jeffery ,&nbsp;Z. Peterson ,&nbsp;B. Shifa ,&nbsp;M. Attia ,&nbsp;K. Badawy ,&nbsp;A. Purushotham","doi":"10.1016/j.jcpo.2024.100494","DOIUrl":"10.1016/j.jcpo.2024.100494","url":null,"abstract":"<div><h3>Introduction</h3><p>Studies have shown that certain groups of patients are underrepresented in clinical trials including non-Caucasian ethnicity, poor fluency in English, low socioeconomic status, older age, neurodivergence, and large Body Mass Index (BMI). There is a need to ensure adequate representation of these groups so that the results of any trial accurately reflect the population.</p><p>The aim of this study was to review the pathway of patients recruited into two early phase breast cancer clinical and determine the inclusivity of patients from the aforementioned sub-groups.</p></div><div><h3>Methods</h3><p>The Breast Cancer Research Database was reviewed, and the characteristics of all patients who were screened for eligibility in two early phase clinical trials was examined. The English Indices of Deprivation was used to populate the Index of Multiple Deprivation (IMD) for each patient using their postcode.</p></div><div><h3>Results</h3><p>In total, 392 patients were eligible to participate, between September 2020 to May 2023. Of these, 144 (36.7 %) were recruited to these two trials. In all, 100 % of patients eligible for these trials were approached and screened for participation. Eligible patients had a mean age of 53.5 years. Recruited patients were younger on average than those not recruited (49.1 years vs 56.0 years, p&lt;0.0001). Only one recruited patient required an interpreter, compared with 24 (9.7 %%) of those who were not recruited (p&lt;0.001).</p><p>There was no difference in the IMD (p=0.38), BMI (p=0.34) and neurodiversity (p=0.10) between patients recruited into clinical trials and those who were not.</p></div><div><h3>Conclusion</h3><p>Older age and poor fluency in the English language remain barriers to participation in early-phase clinical trials despite implementing a clear pathway to trial recruitment. There is a pressing need to address these barriers by raising awareness, improve appropriate training and providing comprehensive trial information to patients in the language of their choice.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100494"},"PeriodicalIF":2.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world cost-effectiveness of panel-based genomic testing to inform therapeutic decisions for metastatic colorectal cancer","authors":"Reka E. Pataky ,&nbsp;Deirdre Weymann ,&nbsp;Ian Bosdet ,&nbsp;Stephen Yip ,&nbsp;Stirling Bryan ,&nbsp;Mohsen Sadatsafavi ,&nbsp;Stuart Peacock ,&nbsp;Dean A. Regier","doi":"10.1016/j.jcpo.2024.100496","DOIUrl":"10.1016/j.jcpo.2024.100496","url":null,"abstract":"<div><h3>Background</h3><p>Mutations in <em>KRAS</em> and <em>NRAS</em> are associated with a lack of response to cetuximab and panitumumab, two biologics used for third-line therapy of metastatic colorectal cancer (mCRC). In British Columbia, Canada, eligibility for cetuximab or panitumumab was first based on single-gene <em>KRAS</em> testing. OncoPanel, a multi-gene next-generation sequencing panel with both <em>KRAS</em> and <em>NRAS</em>, was introduced in 2016. Our objective was to estimate the real-world cost-effectiveness of OncoPanel versus to single-gene <em>KRAS</em> testing to inform eligibility for cetuximab or panitumumab in mCRC.</p></div><div><h3>Methods</h3><p>Using population-based administrative health data, we identified a cohort of mCRC patients who had received a <em>KRAS</em> or OncoPanel test, and completed prior chemotherapy in 2010–2019. We matched <em>KRAS</em>- and OncoPanel-tested patients (1:1) using genetic matching to balance baseline covariates. Mean and incremental 3-year costs, survival, and quality-adjusted survival were estimated using inverse-probability-of-censoring weighting and bootstrapping. We conducted scenario-based sensitivity analysis for key costs and assumptions.</p></div><div><h3>Findings</h3><p>All OncoPanel-tested cases (n=371) were matched to a <em>KRAS</em>-tested comparator. In the <em>KRAS</em> and OncoPanel groups, respectively, 55·8 % and 41·2 % of patients were potentially eligible for cetuximab or panitumumab based on mutation status. Incremental cost and effectiveness of OncoPanel were $72 (95 % CI: −6387, 6107), −0·004 life-years (95 % CI: −0·119, 0·113), and −0·011 quality-adjusted life-years (95 % CI: −0·094, 0·075). Reductions in systemic therapy costs were offset by increased costs in other resources. Results were moderately sensitive to time horizon and changes in testing or treatment cost.</p></div><div><h3>Interpretation</h3><p>The use of OncoPanel resulted in more precise targeting of cetuximab and panitumumab, but there was no change in incremental cost or quality-adjusted survival. Understanding the balance of costs achieved in practice can provide insight into the effect of future changes in testing policy, test cost, treatment eligibility, or drug prices in this setting.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"41 ","pages":"Article 100496"},"PeriodicalIF":2.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538324000304/pdfft?md5=54132aeba8d8f707a75493f9b1a6b33f&pid=1-s2.0-S2213538324000304-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141732071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}