Cost-Effectiveness Analysis of Using Loss of Heterozygosity to Manage Premalignant Oral Dysplasia in British Columbia, Canada

Abstract

Background. Management of low-grade oral dysplasias (LGDs) is complicated, as only a small percentage of lesions will progress to invasive disease. The current standard of care requires patients to undergo regular monitoring of their lesions, with intervention occurring as a response to meaningful clinical changes. Recent improvements in molecular technologies and understanding of the biology of LGDs may allow clinicians to manage lesions based on their genome-guided risk. Methods. We used a decision-analytic Markov model to estimate the cost-effectiveness of risk-stratified care using a genomic assay. In the experimental arm, patients with LGDs were managed according to their risk profile using the assay, with low- and intermediate-risk patients given longer screening intervals and high-risk patients immediately treated with surgery. Patients in the comparator arm had standard care (biannual follow-up appointments at an oral cancer clinic). Incremental costs and outcomes in life-years gained (LYG) and quality-adjusted life-years (QALY) were calculated based on the results in each arm. Results. The mean cost of assay-guided management was $8,123 (95% confidence interval [CI] $2,973 to $23,062 in 2013 Canadian dollars) less than the cost of standard care. This difference was driven largely by reductions in resource use among people who did not develop cancer. Mean incremental effectiveness was 0.18 LYG (95% CI 0.08 to 0.39) or 0.64 QALY (95% CI 0.46 to 0.89). Sensitivity analysis suggests that these findings are robust to both expected and extreme variation in all parameter values. Conclusion. Use of the assay-guided management strategy costs less and is more effective than standard management of LGDs.

Molecular markers associated with development and progression of potentially premalignant oral epithelial lesions: Current knowledge and future implications

“…43 In a study from British Columbia, in Canada, a cost-effectiveness analysis based on such evidence showed that the use of a genomic assay to riskstratify the management of low-grade dysplasia may lead not only to improved patient outcome but also to a more rational allocation of resources. 44 Considering that both hyperplastic and normalappearing mucosa have been reported to undergo MT, it would also be beneficial to have more precise data on nondysplastic lesions, which may represent the vast majority of PPOELs. 45,46 Of note, in the first study by Mao et al 38 and in a more recent one by Gomes et al, 47 it was observed that multiple samples from patients with oral dysplastic lesions showed molecular heterogeneity not associated with any identifiable clinical parameters.…”

Cost‐effectiveness of oral cancer screening approaches by visual examination: Systematic review

“…No additional articles were found after screening the reference list of initially identified papers. Twenty articles 14,15,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] were eliminated for a reason, and seven articles [36][37][38][39][40][41][42] were eligible and included.…”

Loss of FANCD2 and related proteins may predict malignant transformation in oral epithelial dysplasia

“…This should explore possibilities of refining the processes presented in this study, to streamline the diagnostic pathway so that clinical application would be feasible and cost effective. It remains to be seen if the FANCD2-OED Risk score could be more accurate in the prediction of malignant transformation when compared to loss of heterozygosity (47), or perhaps they could be utilised jointly. This could inform the development of future novel treatment strategies in the management of OED.…”