Can personalized cancer care be cost-effective?

August 14, 2015

A study of personalized cancer care in action found that this approach not only saved money but resulted in better outcomes. Such personalized cancer treatment is available here in Ontario.

A small study by Intermountain Healthcare, in Salt Lake City, compared the costs of using personalized medicine in cancer patients with late stage, metastatic disease. Patients whose therapy selection was based on next-generation tumour profiling testing rather than using standard chemotherapy options have lower costs per week and longer progression-free survival.

Personalized approaches to cancer treatment are being tested at many centers, including Ontario’s Princess Margaret Cancer Centre, which launched the “IMPACT” trial (for “Integrated Molecular Profiling in Advanced Cancer Trial”) in March, 2012. This trial is described as “the first Canadian comprehensive molecular profiling program that seeks to provide doctors with specific cancer gene information so that each patient’s treatment can be tailored to his/her specific form of the disease” and aims to test 1,000 patients.

Intermountain Healthcare has been offering a similar type of test, a 98-gene cancer panel test for genes commonly altered in solid tumours. The test involves sequencing over 1200 regions of these 98 genes. The results can be used to identify the appropriate targeted therapeutic specific to the genetic profile of a patient’s tumour. In a retrospective matched cohort study of 72 patients with metastatic cancer, patients at Intermountain Healthcare that received the gene panel test had an average progression-free survival of 22.9 weeks compared to 12 weeks for the group that received standard chemotherapy treatment. The respective costs per week were slightly lower in the gene panel group, at US$3,204 vs. US$3,501. The $6,000 price of the test was included in the cost analysis.

The key contributors to the costs in chemotherapy arm “were more and longer hospital stays and emergency room visits.” In addition to avoiding such hospital visits, “targeted therapies offer other benefits. Many of the targeted drugs are oral agents, which allow patients to take them at home or work, while continuing to be productive at work and go about their daily life. They don’t have to take time off work to go into the hospital for chemotherapy treatment” according to the authors of the study. These ancillary benefits were not factored into the above cost analysis, suggesting that the overall cost benefit is even higher.

Full details of the Intermountain Healthcare study are yet to be released (the work was presented in abstract form in conjunction with the recent annual meeting of the American Society of Clinical Oncology). Yet they suggest that the promise of personalized medicine of reducing costs while improving care can be realized. A key influencer of this, however, will be the cost of targeted therapeutics. As discussed in the accompanying article “Rising prices for new targeted therapeutics threatens their own success” new approaches are needed to ensure that high costs don’t derail the potential of personalized medicine.

By: Kathryn Deuchars, Director, Ontario Personalized Medicine Network