Estimated Cost of Anticancer Therapy Directed by Comprehensive Genomic Profiling in a Single-Center Study

Anita Chawla; Filip Janku; Jennifer J Wheler; Vincent A Miller; Jason Ryan; Rachel Anhorn; Zhou Zhou; James Signorovitch

doi:10.1200/PO.18.00074

Estimated Cost of Anticancer Therapy Directed by Comprehensive Genomic Profiling in a Single-Center Study

JCO Precis Oncol. 2018 Nov 2:2:PO.18.00074. doi: 10.1200/PO.18.00074. eCollection 2018.

Authors

Anita Chawla¹, Filip Janku¹, Jennifer J Wheler¹, Vincent A Miller¹, Jason Ryan¹, Rachel Anhorn¹, Zhou Zhou¹, James Signorovitch¹

Affiliation

¹ , , and , Analysis Group, Boston; , , and , Foundation Medicine, Cambridge, MA; and and , The University of Texas MD Anderson Cancer Center, Houston, TX.

Abstract

Purpose: Comprehensive genomic profiling (CGP) detects several classes of genomic alterations across numerous genes simultaneously and can match more patients with genomically targeted therapies than conventional molecular profiling. The current study estimated the costs of anticancer drugs and overall survival (OS) for patients who were treated with matched and unmatched therapy.

Methods: Costs were estimated for patients with complete data (188 of 500 patients) from a prospective, nonrandomized study of patients with diverse refractory cancers who underwent CGP and were treated with matched or unmatched therapy. We assessed mean time to treatment failure (TTF) and mean observed OS. Patient-specific drug and administration costs were imputed for the first regimen after CGP on the basis of drug classes, unit costs, and time on treatment.

Results: Patients on matched (n = 122) versus unmatched (n = 66) therapy had longer mean TTF (+1.5 months) and observed OS (+2.4 months) and higher drug costs (+$38,065; all P < .01). Increased drug costs were largely attributable to the longer duration of therapy associated with extended TTF (66.3%) rather than higher monthly drug costs (33.7%). Incremental increases in TTF (+1.9 months v +1.2 months) and observed OS (+2.5 months v +2.1 months) between matched and unmatched therapies were larger for those who underwent CGP in earlier- versus later-line therapy. Incremental increases in drug costs between matched and unmatched therapies were lower for earlier- compared with later-line therapy (+$27,000 v +$43,000, respectively).

Conclusion: Matched therapy was associated with longer TTF, increased OS, and manageable incremental cost increases compared with unmatched therapy. Most of these increased costs were a result of the longer duration of therapy rather than higher monthly drug costs. The benefits of matching were numerically greater in earlier versus later lines of therapy, which is consistent with the value of early use of CGP.