Impact on costs and outcomes of multi-gene panel testing for advanced solid malignancies: A cost consequence analysis using linked administrative data.
Notice bibliographique
Résumé
6650 Background: To date, economic analyses of tissue-based next generation sequencing genomic profiling (NGS) have required models with multiple assumptions, with little real-world evidence on overall survival (OS), clinical trial enrollment or end-of-life (EOL) quality of care. The OCTANE clinical trial (NCT02906943) is a prospective study evaluating the role of NGS for advanced solid tumors in Ontario, Canada. We performed a cost consequence analysis of OCTANE. Methods: We undertook a longitudinal, propensity score-matched retrospective cohort study using linked administrative data. OCTANE patients (pts) at Princess Margaret Cancer Centre from August 2016 until March 2019 undergoing NGS panel testing (555 or 163-gene panels) were matched with contemporary controls from across Ontario not enrolled in OCTANE. Patients were matched according to 19 variables including age, sex, place of residence, tumor site, symptom burden, income quintile, comorbidities and prior lines of systemic therapy. Primary outcomes were mean per capita health care costs (2019 Canadian dollars [CAD]) from the public payer’s perspective, OS, clinical trial enrollment and EOL quality metrics. Full 2-year follow-up data was available. Sensitivity analyses considered alternative matched cohort specifications. Results: There were 782 OCTANE pts with 782 matched controls. Variables were balanced after matching (standardized difference [std. diff.]<0.10). Most common tumor sites were: Ovary (30.4%), endometrium (15.0%) breast (12.3%) and colon (8.6%). OCTANE pts had higher mean healthcare costs than controls ($79,702 vs. $59,550), mainly due to costs of oncology visits ($33,165 vs. $26,197), outpatient clinic visits ($8,696 vs. $5,114) and emergency visits ($1,723 vs. $1,373) (all p<0.05). Publicly funded drug costs were less for OCTANE pts ($20,015 vs. $24,465). Overall, OCTANE enrollment was not associated with improved OS (restricted mean survival time (RMST) [standard error]: 1.50 (±0.03) vs. 1.44 (±0.03) years, log-rank p=0.153), but OCTANE was associated with longer OS in ovarian cancer (RMST: 1.69 (±0.05) vs. 1.45 (±0.06) years, p=0.011) and biliary tract tumors (RMST: 1.16 (±0.13) vs. 0.80 (±0.11) years, p=0.02). Importantly, OCTANE correlated with increased clinical trial enrollment (25.5% vs. 9.5%, p<0.001) and better EOL quality due to fewer deaths in hospital (10.2% vs 16.4%, p=0.003). Results were robust in sensitivity analysis. Conclusions: There was an increase in healthcare costs associated with NGS testing for advanced cancers. The impact on OS was not significant in the overall population, but varied across tumor types. OCTANE was associated with greater trial enrollment, lower publicly funded drug costs and fewer in hospital deaths suggesting important considerations in determining the value of NGS for advanced cancers. Clinical trial information: NCT02906943 .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,004 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».