Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations

Abstract Background Due to its epidemiological relevance, several studies have been performed to assess the cost-effectiveness of diagnostic tests and treatments in colorectal cancer (CRC) patients. Objective We reviewed economic evaluations on diagnosis of inherited CRC-syndromes and genetic tests...

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Main Authors: Annamaria Guglielmo, Nicoletta Staropoli, Monica Giancotti, Marianna Mauro
Format: Article
Language:English
Published: BMC 2018-01-01
Series:Cost Effectiveness and Resource Allocation
Subjects:
CRC
Online Access:http://link.springer.com/article/10.1186/s12962-018-0085-z
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spelling doaj-ec52958c0ff9465f97fa61fa02e249e82020-11-24T21:39:53ZengBMCCost Effectiveness and Resource Allocation1478-75472018-01-0116111410.1186/s12962-018-0085-zPersonalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluationsAnnamaria Guglielmo0Nicoletta Staropoli1Monica Giancotti2Marianna Mauro3Department of Clinical and Experimental Medicine, “Magna Græcia” UniversityDepartment of Clinical and Experimental Medicine, “Magna Græcia” UniversityDepartment of Clinical and Experimental Medicine, “Magna Græcia” UniversityDepartment of Clinical and Experimental Medicine, “Magna Græcia” UniversityAbstract Background Due to its epidemiological relevance, several studies have been performed to assess the cost-effectiveness of diagnostic tests and treatments in colorectal cancer (CRC) patients. Objective We reviewed economic evaluations on diagnosis of inherited CRC-syndromes and genetic tests for the detection of mutations associated with response to therapeutics. Methods A systematic literature review was performed by searching the main literature databases for relevant papers on the field, published in the last 5 years. Results 20 studies were included in the final analysis: 14 investigating the cost-effectiveness of hereditary-CRC screening; 5 evaluating the cost-effectiveness of KRAS mutation assessment before treatment; and 1 study analysing the cost-effectiveness of genetic tests for early-stage CRC patients prognosis. Overall, we found that: (a) screening strategies among CRC patients were more effective than no screening; (b) all the evaluated interventions were cost-saving for certain willingness-to-pay (WTP) threshold; and (c) all new CRC patients diagnosed at age 70 or below should be screened. Regarding patients treatment, we found that KRAS testing is economically sustainable only if anticipated in patients with non-metastatic CRC (mCRC), while becoming unsustainable, due to an incremental cost-effectiveness ratio (ICER) beyond the levels of WTP-threshold, in all others evaluated scenarios. Conclusions The poor evidence in the field, combined to the number of assumptions done to perform the models, lead us to a high level of uncertainty on the cost-effectiveness of genetic evaluations in CRC, suggesting that major research is required in order to assess the best combination among detection tests, type of genetic test screening and targeted-therapy.http://link.springer.com/article/10.1186/s12962-018-0085-zPersonalized medicineEconomic evaluationCost-effectiveness analysisColorectal cancerCRC
collection DOAJ
language English
format Article
sources DOAJ
author Annamaria Guglielmo
Nicoletta Staropoli
Monica Giancotti
Marianna Mauro
spellingShingle Annamaria Guglielmo
Nicoletta Staropoli
Monica Giancotti
Marianna Mauro
Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
Cost Effectiveness and Resource Allocation
Personalized medicine
Economic evaluation
Cost-effectiveness analysis
Colorectal cancer
CRC
author_facet Annamaria Guglielmo
Nicoletta Staropoli
Monica Giancotti
Marianna Mauro
author_sort Annamaria Guglielmo
title Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
title_short Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
title_full Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
title_fullStr Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
title_full_unstemmed Personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
title_sort personalized medicine in colorectal cancer diagnosis and treatment: a systematic review of health economic evaluations
publisher BMC
series Cost Effectiveness and Resource Allocation
issn 1478-7547
publishDate 2018-01-01
description Abstract Background Due to its epidemiological relevance, several studies have been performed to assess the cost-effectiveness of diagnostic tests and treatments in colorectal cancer (CRC) patients. Objective We reviewed economic evaluations on diagnosis of inherited CRC-syndromes and genetic tests for the detection of mutations associated with response to therapeutics. Methods A systematic literature review was performed by searching the main literature databases for relevant papers on the field, published in the last 5 years. Results 20 studies were included in the final analysis: 14 investigating the cost-effectiveness of hereditary-CRC screening; 5 evaluating the cost-effectiveness of KRAS mutation assessment before treatment; and 1 study analysing the cost-effectiveness of genetic tests for early-stage CRC patients prognosis. Overall, we found that: (a) screening strategies among CRC patients were more effective than no screening; (b) all the evaluated interventions were cost-saving for certain willingness-to-pay (WTP) threshold; and (c) all new CRC patients diagnosed at age 70 or below should be screened. Regarding patients treatment, we found that KRAS testing is economically sustainable only if anticipated in patients with non-metastatic CRC (mCRC), while becoming unsustainable, due to an incremental cost-effectiveness ratio (ICER) beyond the levels of WTP-threshold, in all others evaluated scenarios. Conclusions The poor evidence in the field, combined to the number of assumptions done to perform the models, lead us to a high level of uncertainty on the cost-effectiveness of genetic evaluations in CRC, suggesting that major research is required in order to assess the best combination among detection tests, type of genetic test screening and targeted-therapy.
topic Personalized medicine
Economic evaluation
Cost-effectiveness analysis
Colorectal cancer
CRC
url http://link.springer.com/article/10.1186/s12962-018-0085-z
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