Abstract 5494: Cost analysis of genomic-directed therapy in patients with metastatic lung and colorectal cancers
Authors: Tutera Seth , Olson Marissa , Williams Casey , Leyland-Jones Brian , Huber Mark , McKean Heidi , Tolentino Addison 
Published: August 2015

Abstract
Purpose
Cancer represents a significant burden on the economy. The NCI estimated that this cost will exceed $158 billion in 2020. As cancer-related costs increase, it is pertinent to explore alternative treatment strategies. The advent of cancer genome sequencing has had a profound effect on the perception of the current treatment standards. Recent findings suggest a transition to a new treatment paradigm in which targeted therapies are chosen based upon unique genetic alterations regardless of cancer type. The purpose of this cost analysis is to assess the impact of genomic-directed treatment on the direct cost of therapy.
Methodology
A systematic search was conducted in a database that consisted of 64 patients that had undergone genetic sequencing. The study included patients that had a molecular genomics profile completed and excluded patients without any treatable genetic mutations. The data analyzed included patient's previous treatment and its costs. Standard doses were assumed in the cost analysis if no dose was provided in the chart. The genomic directed treatment was determined by the genomic oncology team based upon the findings from the molecular genomic profile report. The standard next line therapy was determined from progress notes in the patient chart before they were referred to genomic sequencing, or chosen using the NCCN guidelines. All costs were calculated using wholesale acquisition costs from REDBOOK Online.
Results
Ten patients were analyzed. All patients received adjuvant systemic chemotherapy that followed current treatment standards reflected by the NCCN guidelines. Before being referred to the genomic sequencing service, the number of previous regimens ranged from 1 to 10 lines of therapy over durations that varied from 18 - 76 months. The total cost of treatment before sequencing ranged from $12,722.59 - $396,197.19 with the treatment cost/ month ranging from $978.66 - $12,381.16. Potential standard next -line therapy ranged from $4403.09 - $12,370.06/month and the genomic-directed therapy ranged from $7,231.46 - $22,469.87/month. As expected, most of the genomic-directed therapy regimens were more expensive than the potential standard next-line therapy. In 1 patient, the genomic-directed therapy was less expensive than the potential standard next-line therapy.
Conclusion
Genomic-directed therapy is more expensive than current treatment standards due to the use of newer and more expensive biologic agents. However, current standard therapies focus on the location of the disease and do not target the specific driving feature of the malignancy. The current approach often results in the use of multiple agents in multiple lines of therapy, consequently driving up the cost of therapy. Genomic-directed therapy may result in better outcomes that translate to less treatment being needed and a decrease in the total cost of treatment. Further studies are needed to assess the benefit of genomic-directed therapy.
Citation Format: Seth Tutera, Marissa Olson, Casey Williams, Brian Leyland-Jones, Mark Huber, Heidi McKean, Addison Tolentino. Cost analysis of genomic-directed therapy in patients with metastatic lung and colorectal cancers. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5494. doi:10.1158/1538-7445.AM2015-5494