Cost-effectiveness analysis of universal germline testing for patients with pancreatic cancer. Surgery 2021 Mar;169(3):629-635
Date
08/23/2020Pubmed ID
32826069DOI
10.1016/j.surg.2020.06.038Scopus ID
2-s2.0-85089521842 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Historically, germline testing of patients with pancreatic cancer was performed selectively in patients with a strong family history of cancer. Current guidelines recommend universal testing because some patients may have actionable germline pathogenic variants without family history.
METHODS: We conducted a cost-effectiveness analysis using a decision-tree model to compare universal versus selective testing strategies for patients with pancreatic cancer. Costs, probabilities, and overall survival were estimated from the published literature and institutional data. One-way and probabilistic sensitivity analyses explored model uncertainty.
RESULTS: Universal germline genetic testing had an incremental cost of $310 with an increase of 0.003 life-years. The incremental cost-effectiveness ratio was $121,924/life-years. Parameters which were most impactful (sensitivity analysis) included the median overall survival of patients with advanced disease treated with personalized therapy, cost of personalized therapy for advanced disease, and the probability of receiving personalized therapy in advanced disease. A strategy of selective testing was more cost-effective in 59% of iterations when the willingness-to-pay threshold was set to $100,000/life-years.
CONCLUSION: Our model suggested that selective germline testing of patients with newly diagnosed pancreatic cancer is more cost-effective than universal testing. Additional research is needed to explore the impact of cascade testing of relatives on cost-effectiveness.
Author List
Krepline AN, Geurts JL, George B, Kamgar M, Madhavan S, Erickson BA, Hall WA, Griffin MO, Evans DB, Tsai S, Kim RYAuthors
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of WisconsinDouglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Jennifer L. Geurts MS Director, Associate Professor in the Institute for Health and Humanity department at Medical College of Wisconsin
Michael O. Griffin PhD, MD Associate Professor in the Radiology department at Medical College of Wisconsin
William Adrian Hall MD Chair, Professor in the Radiation Oncology department at Medical College of Wisconsin
Mandana Kamgar MPH, MD Associate Professor in the Medicine department at Medical College of Wisconsin
Srivats Madhavan MBBS Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Cost-Benefit AnalysisDecision Support Techniques
Decision Trees
Disease Management
Genetic Testing
Germ Cells
Humans
Medical Oncology
Models, Theoretical
Pancreatic Neoplasms
Precision Medicine
Public Health Surveillance
