日本未治疗的晚期或复发性实体瘤全面基因组分析的预算影响分析。

Budget impact analysis of comprehensive genomic profiling for untreated advanced or recurrent solid cancers in Japan.

机构信息

Chugai Pharmaceutical Co., Ltd, Tokyo, Japan.

Crecon Medical Assessment Co., Ltd, Tokyo, Japan.

出版信息

J Med Econ. 2023 Jan-Dec;26(1):614-626. doi: 10.1080/13696998.2023.2202599.

DOI:10.1080/13696998.2023.2202599

PMID:37073487

Abstract

AIMS

In Japan, the use of comprehensive genomic profiling (CGP) is only available for cancer patients who have no standard of care (SoC), or those who have completed SoC. This may lead to missed treatment opportunities for patients with druggable alterations. In this study, we evaluated the potential impact of CGP testing before SoC on medical costs and clinical outcome in untreated patients with advanced or recurrent biliary tract cancer (BTC), non-squamous non-small cell lung cancer (NSQ-NSCLC), or colorectal cancer (CRC) in Japan between 2022 and 2026.

MATERIALS AND METHODS

We constructed a decision-tree model reflecting the healthcare environment of Japan, to estimate the clinical outcome and medical costs impact of CGP testing by comparing two groups (with vs without CGP testing before SoC). The epidemiological parameters, detection rates of druggable alterations, and overall survival were collected from literature and claims databases in Japan. Treatment options selected based on druggable alterations were set in the model based on clinical experts' opinions.

RESULTS

In 2026, the number of untreated patients with advanced or recurrent BTC, NSQ-NSCLC, and CRC was estimated to be 8600, 32,103, and 24,896, respectively. Compared with the group without CGP testing before SoC, CGP testing before SoC increased druggable alteration detection and treatment rate with matched therapies in all three cancer types. The medical costs per patient per month were estimated to increase with CGP testing before SoC in the three cancer types by 19,600, 2900, and 2200 JPY (145, 21, and 16 USD), respectively.

LIMITATIONS

Only those druggable alterations with matched therapies were considered in the analysis model, while the potential impact of other genomic alterations provided by CGP testing was not considered.

CONCLUSIONS

The present study suggested that CGP testing before SoC may improve patient outcomes in various cancer types with a limited and controllable increase in medical costs.

摘要

目的

在日本，综合基因组分析（CGP）仅用于没有标准治疗方案（SoC）或已完成 SoC 的癌症患者。这可能导致有可用药理改变的患者错失治疗机会。本研究评估了 2022 年至 2026 年期间日本未经治疗的晚期或复发性胆道癌（BTC）、非鳞状非小细胞肺癌（NSQ-NSCLC）或结直肠癌（CRC）患者在接受 SoC 前进行 CGP 检测对医疗成本和临床结局的潜在影响。

材料和方法

我们构建了一个反映日本医疗保健环境的决策树模型，通过比较接受 SoC 前进行 CGP 检测与不进行 CGP 检测的两组患者，评估 CGP 检测对临床结局和医疗成本的影响。从日本文献和理赔数据库中收集了流行病学参数、可用药理改变的检测率和总生存期数据。根据可用药理改变选择的治疗方案是基于临床专家的意见设置在模型中的。

结果

2026 年，预计晚期或复发性 BTC、NSQ-NSCLC 和 CRC 的未经治疗患者数量分别为 8600、32103 和 24896 例。与未接受 SoC 前的 CGP 检测组相比，SoC 前的 CGP 检测在所有三种癌症类型中均提高了可用药理改变的检测率和治疗率，并匹配了治疗方案。预计在三种癌症类型中，每位患者每月的医疗成本将因 SoC 前的 CGP 检测而分别增加 19600、2900 和 2200 日元（145、21 和 16 美元）。