Do cancer biomarkers make targeted therapies cost-effective? A systematic review in metastatic colorectal cancer.
File(s)
Published version
Author(s)
Seo, Mikyung Kelly
Cairns, John
Type
Journal Article
Abstract
BACKGROUND: Recent advances in targeted therapies have raised expectations that the clinical application of biomarkers would improve patient's health outcomes and potentially save costs. However, the cost-effectiveness of biomarkers remains unclear irrespective of the cost-effectiveness of corresponding therapies. It is thus important to determine whether biomarkers for targeted therapies provide good value for money. This study systematically reviews economic evaluations of biomarkers for targeted therapies in metastatic colorectal cancer (mCRC) and assesses the cost-effectiveness of predictive biomarkers in mCRC. METHODS: A literature search was performed using Medline, Embase, EconLit, NHSEED. Papers published from 2000 until June 2018 were searched. All economic evaluations assessing biomarker-guided therapies with companion diagnostics in mCRC were searched. To make studies more comparable, cost-effectiveness results were synthesized as per biomarker tests and corresponding therapies. Methodological quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS: Forty-six studies were included in this review. Of these, 17 studies evaluated the intrinsic value of cancer biomarkers, whereas the remaining studies focused on assessing the cost-effectiveness of corresponding drugs. Most studies indicated favourable cost-effectiveness of biomarkers for targeted therapies in mCRC. Some studies reported that biomarkers were cost-effective, while their corresponding therapies were not cost-effective. A considerable number of economic evaluations were conducted in pre-defined genetic populations and thus, often failed to fully capture the biomarker's clinical and economic values. The average QHES score was 73.6. CONCLUSION: Cancer biomarkers for targeted therapies in mCRC were mostly found to be cost-effective; otherwise, they at least improved the cost-effectiveness of targeted therapies by saving some costs. However, this did not necessarily make their corresponding therapies cost-effective. While companion biomarkers reduced therapy costs, the savings were not sufficient to make the corresponding agents cost-effective. Evaluation of biomarkers was often restricted to the cost of tests and did not consider their clinical values or biomarker prevalence.
Date Issued
2018-09-26
Date Acceptance
2018-09-10
Citation
PLoS One, 2018, 13 (9), pp.1-23
ISSN
1932-6203
Publisher
Public Library of Science (PLoS)
Start Page
1
End Page
23
Journal / Book Title
PLoS One
Volume
13
Issue
9
Copyright Statement
© 2018 Seo, Cairns. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30256829
PII: PONE-D-18-05107
Subjects
Biomarkers, Tumor
Colorectal Neoplasms
Cost-Benefit Analysis
Glucuronosyltransferase
Humans
Molecular Targeted Therapy
Neoplasm Metastasis
Precision Medicine
Proto-Oncogene Proteins p21(ras)
Quality Assurance, Health Care
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-09-26