Economic impact of genomic diagnostics for intermediate‐risk acute myeloid leukaemia

Abstract

SummaryAcute Myeloid Leukaemia (AML) is a rare but serious group of diseases that require critical decision‐making for curative treatment. Over the past decade, scientific discovery has revealed dozens of prognostic gene mutations for AML while sequencing costs have plummeted. In this study, we compared the cost‐effectiveness of multigene integrative analysis (genomic analysis) with the standard molecular testing currently used for diagnosis of intermediate‐risk AML. We used a decision analytic model with data for costs and outcomes from British Columbia, Canada, to assess the long‐term (10‐year) economic impacts. Our results suggest that genomic analysis would result in a 26% increase in the use of first‐remission allogeneic stem cell transplantation. The resulting treatment decisions and downstream effects would come at an additional cost of $12 556 [2013 Canadian dollars (CAD)] per person and the incremental cost‐effectiveness ratio would be $49 493 per quality‐adjusted life‐year gained. Cost‐effectiveness was dependent on quality of life during the long‐term (5–10) years of survival, relapse rates following first‐remission chemotherapy and the upfront cost of transplantation. Non‐relapse mortality rates, short‐term quality of life and the cost of genomic sequencing had only minor impacts. Further research on post‐remission outcomes can lead to improvements in the cost‐effectiveness of curative treatments for AML.

Cost-Effectiveness Analysis of a HMGA2 Prognostic Test for Acute Myeloid Leukemia in a Canadian Setting

“…To our knowledge, the only previous analysis describing the impact of genomic diagnostics in a Canadian setting is a cost-effectiveness decision analytic model developed by Cressman et al [24]. The results of their analysis are somewhat comparable to ours as they also assessed the cost effectiveness of stratifying patients with intermediate-risk AML over a 10-year time horizon.…”

“…The results of their analysis are somewhat comparable to ours as they also assessed the cost effectiveness of stratifying patients with intermediate-risk AML over a 10-year time horizon. They estimated that genomic analysis would result in increased use of first-remission allogeneic stem cell transplantation leading to an additional cost of $12,556 (2013 CAD) and 0.26 QALYs over the standard of care, while our analysis estimated an incremental cost of − $10,687 (2019 CAD) and 0.073 QALYs (discounted) during a 10-year time horizon (owing to re-stratification of patients to investigational therapies and earlier HSCT in first remission) [24]. However, the difference may be attributed to the use of a multigene stratification system of ten selected prognostic genes, which may be more accurate in reclassifying intermediate-risk group patients than the single-gene system ( HMGA2 − / HMGA2 + ) assessed in our model.…”

Precision oncology for acute myeloid leukemia using a knowledge bank approach

“…Health utilities for AML survival with and without stem cell transplants have previously been estimated as 0.74 and 0.83, respectively 19 , and the cost of an allograft as US$100,000–200,000 20 . Thus an increase of 1.3 percentage points in long-term survival while maintaining a 30% allograft rate in CR1 corresponds to ~0.1 QALYs gained per patient over ten years.…”

Genomic testing in myeloid malignancy

“…Additional studies with longer follow‐up periods are required to establish the proportion of patients with mutations in different CHIP genes who go on to develop a hematological malignancy. When patients present with clear signs of MDS or AML, diagnostic testing is clearly indicated and cost‐effective . Genomic testing can help establish a definitive diagnosis, potentially identifying alternative hematological malignancies.…”

“…When patients present with clear signs of MDS or AML, diagnostic testing is clearly indicated and cost-effective. 72 Genomic testing can help establish a definitive diagnosis, potentially identifying alternative hematological malignancies.…”