Cost-effectiveness of hypothetical miRNA biomarker testing for post-treatment surveillance of HPV-negative OPSCC

Abstract

ObjectiveTo determine the theoretical cost-effectiveness of a miRNA-biomarker test for HPV– oropharyngeal squamous cell carcinoma surveillance compared to current National Comprehensive Cancer Network (NCCN) guidelines. Study designCost-effectiveness modeling using a hypothetical patient cohort. SettingThe participants in the model were disease-free patients aged 18+ in the United States who are in remission after completing treatment for HPV- OPSCC. MethodsA Markov model simulated the different post-treatment surveillance options available and probabilities for recurrence at various time-points. A sensitivity analysis adjusted for variations in cost and biomarker test characteristics. ResultsThe NCCN pathway was $4028.38 more costly and 0.05 QALY more effective than the miRNA pathway. The Extra Imaging pathway was $16,619.83 more costly and 0.18 QALY more effective than the miRNA pathway. The ICER between the miRNA and NCCN strategy was $81,074/QALY and $100,815/QALY between the NCCN and Extra Imaging pathways. The biomarker serum surveillance pathway is more cost-effective than the NCCN approach until the willingness to pay (WTP) threshold exceeds ∼$82,000. At the standard WTP threshold of $50,000/QALY, the serum test pathway is more cost-effective. We also determined the theoretical characteristics of a cost-effective miRNA test. Probabilistic analysis revealed a cost-effective miRNA test should cost less than $451.80, have a sensitivity of greater than 57 %, and a specificity greater than 50 %. ConclusionThe miRNA biomarker strategy is a cost-effective surveillance option for HPV- oropharyngeal cancer. By reducing the reliance on repeated imaging, radiation and in-person follow-up, this strategy can provide more equitable and accessible healthcare.