Patients’ willingness to pay for blood-based <i>EGFR</i> <i>T790M</i> testing: Results from a Canadian validation study of circulating DNA <i>T790M</i> testing.
Bibliographic record
Abstract
e18329 Background: Detection of EGFRmutations in circulating tumor DNA (ctDNA) in peripheral blood has been shown to have high concordance with definitive tumor biopsy samples. Patients’ perceived value and willingness to pay for novel technology can help inform policy and funding decisions in the public healthcare system. Methods: Canadian patients undergoing screening for the ASTRIS clinical trial (NCT02474355) were invited to participate in a national Canadian validation study of blood-based ctDNA T790M testing. All participants had metastatic EGFRmutant lung cancer with acquired resistance to EGFR kinase inhibitors. In addition to collection of blood samples and demographic data, patients completed a structured interview measuring their perceived value of blood-based ctDNA testing as an alternative to tumor biopsy and willingness to pay for testing using both open-ended and iterative bidding approaches. The study was supported by a grant from AstraZeneca. Results: 55 patients have been accrued of a planned 60. As of 01/31/2017, demographic data for 55 and willingness to pay data for 52 patients were available, the rest are pending. The median age of the cohort is 64 years (range 31-87), 68% are Asian (36/53), 56% female (31/55). Patients received a median of 1 prior line of treatment (range 1-7); all received prior EGFR kinase inhibitor therapy (66% gefitinib), and 34% also received prior cytotoxic chemotherapy (18/53). All but one patient preferred to have the blood test over repeat tumor biopsy. Patients were personally willing to pay a median of $400 CAD for the test (IQR $600, range 0-$10000). Patients estimated that a reasonable price for the test was a median of $150 (IQR $300, range 0-$2500). Conclusions: Lung cancer patients value ctDNA testing highly and prefer it to tumor biopsy. Despite the expectation that services like molecular testing should be covered through the Canadian public healthcare system, patients expressed willingness to pay out of pocket for ctDNA blood testing, reflecting perceived major value of this technology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".