Multiplatform Tumor Profiling Delivers Value Based Health Care In Refractory Cancer Patients

Abstract

Caris Molecular Intelligence® (CMI) is a multiplatform tumor profiling service helping patients with refractory cancer who are past standard of care to find treatment options. In the UK, the National Institute for Health and Clinical Excellence (NICE) has implemented an end-of-life (EoL) premium since 2009. The aim of this study is to assess the cost-effectiveness value of CMI in a health system. A model described by McCabe and colleagues is adapted to show the value of CMI. To populate the model, threshold cost and real-world incremental cost-effectiveness ratio (ICER) data from the health technology assessments performed by NICE in the past year (November 2015-December 2016) were used as comparators. Data collected in a prospective observational study conducted by Caris demonstrated a survival benefit in patents treated in line with the CMI report. An ICER for CMI was calculated based on the demonstrated survival benefit and the clinical utility. To date, NICE recommendations have consistently used a £50,000 per QALY threshold for these EoL treatments. This equates to a health benefit of 7.3 days of additional benefit per £1,000 expenditure by the health care system. A CMI unit price of £5,000 was used in the ICER calculation. According to Caris registry data, CMI can extend overall survival by 138 days (or 0.337 years) for health economic evaluation. CMI-guided therapy is administered in 78% of profiled patients, meaning that a decision impact factor of 0.78 could be included in ICER calculation. The ICER for CMI was calculated as CMI Cost / (QALYs gained x decision impact factor). Based on these assumptions, the ICER for CMI is £19,022 or equivalent to 19.20 days benefit per £1,000 expenditure. Data from this model shows that CMI exceeds the threshold opportunity cost and represents value for health care systems that surpasses many recently approved drugs.