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Weymann D, Laskin J, Jones SJM, Roscoe R, Lim HJ, Renouf DJ, Schrader KA, Sun S, Yip S, Marra MA, Regier DA. Early-stage economic analysis of research-based comprehensive genomic sequencing for advanced cancer care. J Community Genet 2021; 13:523-538. [PMID: 34843087 PMCID: PMC8628132 DOI: 10.1007/s12687-021-00557-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/06/2021] [Indexed: 01/23/2023] Open
Abstract
Genomic research is driving discovery for future population benefit. Limited evidence exists on immediate patient and health system impacts of research participation. This study uses real-world data and quasi-experimental matching to examine early-stage cost and health impacts of research-based genomic sequencing. British Columbia’s Personalized OncoGenomics (POG) single-arm program applies whole genome and transcriptome analysis (WGTA) to characterize genomic landscapes in advanced cancers. Our cohort includes POG patients enrolled between 2014 and 2015 and 1:1 genetic algorithm–matched usual care controls. We undertake a cost consequence analysis and estimate 1-year effects of WGTA on patient management, patient survival, and health system costs reported in 2015 Canadian dollars. WGTA costs are imputed and forecast using system of equations modeling. We use Kaplan-Meier survival analysis to explore survival differences and inverse probability of censoring weighted linear regression to estimate mean 1-year survival times and costs. Non-parametric bootstrapping simulates sampling distributions and enables scenario analysis, revealing drivers of incremental costs, survival, and net monetary benefit for assumed willingness to pay thresholds. We identified 230 POG patients and 230 matched controls for cohort inclusion. The mean period cost of research-funded WGTA was $26,211 (SD: $14,191). Sequencing costs declined rapidly, with WGTA forecasts hitting $13,741 in 2021. The incremental healthcare system effect (non-research expenditures) was $5203 (95% CI: 75, 10,424) compared to usual care. No overall survival differences were observed, but outcome heterogeneity was present. POG patients receiving WGTA-informed treatment experienced incremental survival gains of 2.49 months (95% CI: 1.32, 3.64). Future cost consequences became favorable as WGTA cost drivers declined and WGTA-informed treatment rates improved to 60%. Our study demonstrates the ability of real-world data to support evaluations of only-in-research health technologies. We identify situations where precision oncology research initiatives may produce survival benefit at a cost that is within healthcare systems’ willingness to pay. This economic evidence informs the early-stage healthcare impacts of precision oncology research.
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Affiliation(s)
- Deirdre Weymann
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer Research Centre, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Janessa Laskin
- Division of Medical Oncology, BC Cancer, Vancouver, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Molecular Biology & Biochemistry, Simon Fraser University, Burnaby, Canada
| | - Robyn Roscoe
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada
| | - Howard J Lim
- Division of Medical Oncology, BC Cancer, Vancouver, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel J Renouf
- Division of Medical Oncology, BC Cancer, Vancouver, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kasmintan A Schrader
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Molecular Oncology, BC Cancer, Vancouver, Canada
| | - Sophie Sun
- Division of Medical Oncology, BC Cancer, Vancouver, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Pathology, BC Cancer, Vancouver, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, Canada
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control, Cancer Control Research, BC Cancer Research Centre, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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2
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Wang Y, Rattanavipapong W, Teerawattananon Y. Using health technology assessment to set priority, inform target product profiles, and design clinical study for health innovation. TECHNOLOGICAL FORECASTING AND SOCIAL CHANGE 2021; 172:121000. [PMID: 34732945 PMCID: PMC8524319 DOI: 10.1016/j.techfore.2021.121000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/04/2021] [Accepted: 06/25/2021] [Indexed: 05/29/2023]
Abstract
Early health technology assessment (early HTA) is a useful tool in guiding the innovation development process in medical technology development. However, the application of early HTA is sub-optimal amongst research and development (R&D) communities due to several challenges. In this paper, we presented a case study of application of early HTA by drawing on the experience from a workshop conducted for the Singapore government's medical technology innovation agency. The framework developed can help maximise the chance of the newly developed technology being accepted and widely used. By providing step-by-step guidance, this work aims to translate early HTA into a practical tool and promote the application of early HTA amongst R&D communities.
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Affiliation(s)
- Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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Vreman RA, Geenen JW, Knies S, Mantel-Teeuwisse AK, Leufkens HGM, Goettsch WG. The Application and Implications of Novel Deterministic Sensitivity Analysis Methods. PHARMACOECONOMICS 2021; 39:1-17. [PMID: 33313990 PMCID: PMC7790801 DOI: 10.1007/s40273-020-00979-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 05/15/2023]
Abstract
Deterministic sensitivity analyses (DSA) remain important to interpret the effect of uncertainties in individual parameters on results of cost-effectiveness analyses. Classic DSA methodologies may lead to wrong conclusions due to a lack of or misleading information regarding marginal effects, non-linearity, likelihood and correlations. In addition, tornado diagrams are misleading in some situations. Recent advances in DSA methods have the potential to provide decision makers with more reliable information regarding the effects of uncertainties in individual parameters. This practical application discusses advances to classic DSA methods and their implications. Three methods are discussed: stepwise DSA, distributional DSA and probabilistic DSA. For each method, the technical specifications, options for presenting results, and its implications for decision making are discussed. Options for visualizing DSA results in incremental cost-effectiveness ratios and in incremental net benefits are presented. The use of stepwise DSA increases interpretability of marginal effects and non-linearities in the model, which is especially relevant when arbitrary ranges are implemented. Using the probability distribution of each parameter in distributional DSA provides insight on the likelihood of model outcomes while probabilistic DSA also includes the effects of correlations between parameters.Probabilistic DSA, preferably expressed in incremental net benefit, is the most appropriate method for providing insight on the effect of uncertainty in individual parameters on the estimate of cost effectiveness. However, the opportunities provided by probabilistic DSA may not always be needed for decision making. Other DSA methods, in particular distributional DSA, can sometimes be sufficient depending on model features. Decision makers must determine to which extent they will accept and implement these new and improved DSA methodologies and adjust guidelines accordingly.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 35384 CG, Utrecht, The Netherlands.
- The National Health Care Institute (ZIN), Diemen, The Netherlands.
| | - Joost W Geenen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 35384 CG, Utrecht, The Netherlands
- Roche Nederland BV, Woerden, The Netherlands
| | - Saskia Knies
- The National Health Care Institute (ZIN), Diemen, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 35384 CG, Utrecht, The Netherlands
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 35384 CG, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 35384 CG, Utrecht, The Netherlands
- The National Health Care Institute (ZIN), Diemen, The Netherlands
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Lindenberg MA, Retèl VP, van den Berg JH, Geukes Foppen MH, Haanen JB, van Harten WH. Treatment With Tumor-infiltrating Lymphocytes in Advanced Melanoma: Evaluation of Early Clinical Implementation of an Advanced Therapy Medicinal Product. J Immunother 2019; 41:413-425. [PMID: 30300260 PMCID: PMC6200372 DOI: 10.1097/cji.0000000000000245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/06/2018] [Indexed: 12/18/2022]
Abstract
Tumor-infiltrating lymphocytes (TIL)-therapy in advanced melanoma is an advanced therapy medicinal product (ATMP) which, despite promising results, has not been implemented widely. In a European setting, TIL-therapy has been in use since 2011 and is currently being evaluated in a randomized controlled trial. As clinical implementation of ATMPs is challenging, this study aims to evaluate early application of TIL-therapy, through the application of a constructive technology assessment (CTA). First the literature on ATMP barriers and facilitators in clinical translation was summarized. Subsequently, application of TIL-therapy was evaluated through semistructured interviews with 26 stakeholders according to 6 CTA domains: clinical, economic, patient-related, organizational, technical, and future. In addition, treatment costs were estimated. A number of barriers to clinical translation were identified in the literature, including: inadequate financial support, lack of regulatory knowledge, risks in using live tissues, and the complex path to market approval. Innovative reimbursement procedures could particularly facilitate translation. The CTA survey of TIL-therapy acknowledged these barriers, and revealed the following facilitators: the expected effectiveness resulting in institutional support for an internal pilot, the results of which led to the inclusion of TIL-therapy in a national coverage with evidence development program, the availability of an in-house pharmacist, quality assurance expertise and a TIL-skilled technician. Institutional and national implementation of TIL-therapy remains complex. The promising clinical effectiveness is expected to facilitate the adoption of TIL-therapy, especially when validated through a randomized controlled trial. Innovative and conditional reimbursement procedures, together with the organization of knowledge transfer, could support and improve clinical translation of TIL and ATMPs.
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Affiliation(s)
- Melanie A. Lindenberg
- Division of Psychosocial Research and Epidemiology
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
| | | | - Marnix H. Geukes Foppen
- Division of Molecular Oncology and Immunology
- Department of Medical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam
| | - John B. Haanen
- Division of Molecular Oncology and Immunology
- Department of Medical Oncology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology
- Department of Health Technology and Services research, University of Twente, Enschede, The Netherlands
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Kluytmans A, Tummers M, van der Wilt GJ, Grutters J. Early Assessment of Proof-of-Problem to Guide Health Innovation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:601-606. [PMID: 31104741 DOI: 10.1016/j.jval.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although the relevance of both push and pull factors is acknowledged in models of innovation, needs, broadly defined, are rarely considered, whereas supply-driven innovation in publicly funded health systems carries the risk that it may not match the underlying problems experienced by patients and consumers. OBJECTIVES To explore a mixed-methods, multistakeholder approach that focuses on pertinent problems when assessing the potential value of an innovation as applied to a case of surgical innovation in meniscus surgery. METHODS Through interviews of stakeholders (n = 11) we sought to identify current problems of meniscus surgery in the Netherlands. On the basis of the subsequent problem definitions, we used stakeholder and literature input to quantify the room for improvement and stakeholder engagement to uncover possible barriers and facilitators to the implementation of the proposed innovation. RESULTS Despite being enthusiastic about the ingenuity of the proposed innovation and seeing some potential for cost saving, most stakeholders (n = 10) agreed that there are no major problems in current meniscus surgery meriting the innovation. They even discerned pragmatic barriers that would challenge the potential cost savings. CONCLUSIONS By adopting a problem-oriented multistakeholder approach to early health technology assessment, we were able to estimate the potential value of an innovation in its social context, finding that, beyond the initial enthusiasm, the proposed innovation was unlikely to resolve the problems distinguished by the stakeholders. We concluded that our multistakeholder, mixed-methods approach to early health technology assessment is feasible and helps foster more demand-driven innovations.
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Affiliation(s)
- Anouck Kluytmans
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Jan van der Wilt
- Department for Health Evidence, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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van Harten W, IJzerman MJ. Responsible pricing in value-based assessment of cancer drugs: real-world data are an inevitable addition to select meaningful new cancer treatments. Ecancermedicalscience 2017; 11:ed71. [PMID: 28955404 PMCID: PMC5606291 DOI: 10.3332/ecancer.2017.ed71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Indexed: 11/06/2022] Open
Abstract
Recently, NICE was given the task of governing the Cancer Drug Fund (CDF) in the UK as the latter was criticized for allowing too many insufficiently tested drugs to be covered [1, 2]. The CDF was initiated in 2012, but immediately received criticism from several health economists because of the rather strict coverage criteria that are commonly used by NICE for most other health services in the NHS. This led to questions about the use of different reimbursement criteria (why have a different fund otherwise?) for expensive cancer drugs. Such a separate fund would potentially take away large amounts of the collective health budget. This led to questions about the use of different reimbursement criteria (why have a different fund otherwise?) for expensive cancer drugs compared to other technologies. This is just one example of discussions that are taking place in many countries on the issue of drug coverage policies. This development takes place against a background of increasingly intense discussion on pricing and affordability of (new) cancer drugs, the responsible behavior of pharmaceutical companies that spend public resources for R&D, and the lack of transparency in pricing and R&D expenditure in combination with profit margins of sometimes up to 20%. We argue that Real-World Evidence (RWE) may play a much greater and, on occasion, pivotal role in developing sustainable cancer care, because it allows much better estimates of actual drug use and costs and increases transparency in health outcomes.
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Affiliation(s)
- Wim van Harten
- The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam,The Netherlands
- Health Technology and Services Research (HTSR), University Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Cancer Economics Working Group, European Organization of Cancer Institutes, 11 Rue d'Egmont, B-1000, Brussels, Belgium
- Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research (HTSR), University Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
- Luxembourg Institute of Health, Health Economics and Personalized Medicine, 1A-B, rue Thomas Edison, L-1445 Strassen, Luxembourg
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7
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IJzerman MJ, Koffijberg H, Fenwick E, Krahn M. Emerging Use of Early Health Technology Assessment in Medical Product Development: A Scoping Review of the Literature. PHARMACOECONOMICS 2017; 35:727-740. [PMID: 28432642 PMCID: PMC5488152 DOI: 10.1007/s40273-017-0509-1] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Early health technology assessment is increasingly being used to support health economic evidence development during early stages of clinical research. Such early models can be used to inform research and development about the design and management of new medical technologies to mitigate the risks, perceived by industry and the public sector, associated with market access and reimbursement. Over the past 25 years it has been suggested that health economic evaluation in the early stages may benefit the development and diffusion of medical products. Early health technology assessment has been suggested in the context of iterative economic evaluation alongside phase I and II clinical research to inform clinical trial design, market access, and pricing. In addition, performing early health technology assessment was also proposed at an even earlier stage for managing technology portfolios. This scoping review suggests a generally accepted definition of early health technology assessment to be "all methods used to inform industry and other stakeholders about the potential value of new medical products in development, including methods to quantify and manage uncertainty". The present review also aimed to identify recent published empirical studies employing an early-stage assessment of a medical product. With most included studies carried out to support a market launch, the dominant methodology was early health economic modeling. Further methodological development is required, in particular, by combining systems engineering and health economics to manage uncertainty in medical product portfolios.
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Affiliation(s)
- Maarten J IJzerman
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
- Evidence Synthesis and Health Economics Unit, Luxembourg Institute of Health, Strassen, Luxembourg.
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada
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