Cancer accounts for ~30% of all deaths in Australia, claiming over 45,000 lives each year. It is estimated that the government of Australia spent $4.5 billion on cancer in 2009, accounting for 7% of the total healthcare budget for chronic disease. The impacts on healthcare expenditures of the increasing use of genomic tests to guide treatment selection in oncology are relatively unknown.
The costs of genomic testing to identify patients most likely to respond to treatment and the unique elements of value associated with this type of testing are first discussed. Followed by a discussion of the high cost of targeted therapies and the impact increased clinical use can have on healthcare expenditures. Examples of genomic test and treat strategies that have resulted in a reduction in healthcare expenditures are provided. Lessons that can be learned from these successes are then proposed.
The value assessment of genomic testing in oncology poses some unique methodological challenges for economic evaluations. Approaches for assessing the economic value of a genomic test and treat strategy in model-based economic evaluations are compared and best practice methods are described.
Finally, an applied example of assessing the cost-effectiveness of a multiplex targeted sequencing panel in a test and treat regime compared with no further testing with best supportive care in the last-line treatment of lung adenocarcinoma is provided. The results of this analysis will be used to identify key parameters that have large impacts on overall cost-effectiveness results. The value of reducing uncertainty in these key parameters will also be quantified to determine if future research is worthwhile.
Overall, innovative approaches to the reimbursement of genomic test and treat strategies are likely to be required to facilitate the most appropriate diffusion into clinical care. An iterative approach to the economic evaluation of genomic test and treat strategies will be necessary as our understanding of their impact on health outcomes and the overall health budget improves.