Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist

Doble,B, Tan,M, Harris,A and Lorgelly,P 2015, Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist, Expert review of molecular diagnostics, vol. 15, no. 2, pp. 235-254, doi: 10.1586/14737159.2014.929499.

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Title Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist
Author(s) Doble,B
Journal name Expert review of molecular diagnostics
Volume number 15
Issue number 2
Start page 235
End page 254
Publisher Informa Healthcare
Place of publication London, England
Publication date 2015-04
ISSN 1473-7159
Keyword(s) companion diagnostics
cost-effectiveness analysis
economic evaluation
genomic testing
precision medicine
Summary The successful use of a targeted therapy is intrinsically linked to the ability of a companion diagnostic to correctly identify patients most likely to benefit from treatment. The aim of this study was to review the characteristics of companion diagnostics that are of importance for inclusion in an economic evaluation. Approaches for including these characteristics in model-based economic evaluations are compared with the intent to describe best practice methods. Five databases and government agency websites were searched to identify model-based economic evaluations comparing a companion diagnostic and subsequent treatment strategy to another alternative treatment strategy with model parameters for the sensitivity and specificity of the companion diagnostic (primary synthesis). Economic evaluations that limited model parameters for the companion diagnostic to only its cost were also identified (secondary synthesis). Quality was assessed using the Quality of Health Economic Studies instrument. 30 studies were included in the review (primary synthesis n = 12; secondary synthesis n = 18). Incremental cost-effectiveness ratios may be lower when the only parameter for the companion diagnostic included in a model is the cost of testing. Incorporating the test's accuracy in addition to its cost may be a more appropriate methodological approach. Altering the prevalence of the genetic biomarker, specific population tested, type of test, test accuracy and timing/sequence of multiple tests can all impact overall model results. The impact of altering a test's threshold for positivity is unknown as it was not addressed in any of the included studies. Additional quality criteria as outlined in our methodological checklist should be considered due to the shortcomings of standard quality assessment tools in differentiating studies that incorporate important test-related characteristics and those that do not. There is a need to refine methods for incorporating the characteristics of companion diagnostics into model-based economic evaluations to ensure consistent and transparent reimbursement decisions are made.
Language eng
DOI 10.1586/14737159.2014.929499
Field of Research 111717 Primary Health Care
Socio Economic Objective 920102 Cancer and Related Disorders
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, Informa Healthcare
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Document type: Journal Article
Collections: Faculty of Health
Population Health
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