Cost Estimates and Economic Implications of Expanded RAS Testing in Metastatic Colorectal Cancer. (19th November 2014)

• Record Type: Journal Article
• Authors: Kircher, Sheetal M.; Mohindra, Nisha; Nimeiri, Halla
• Is Part Of: Oncologist. Volume 20(2015)Supplement 1
• Page Start: 14
• Page End: 18
• Publication Date: 2014-11-19
• Subjects: Antineoplastic agents -- Colorectal neoplasms/drug therapy -- Drug costs -- KRAS protein -- Human; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1634/theoncologist.2014-0252
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract : Background: In colorectal cancer (CRC), evidence shows that expanding RAS testing to analyze more mutations may better predict benefit from anti‐EGFR therapy. The economic implications of expanding RAS testing for metastatic CRC were analyzed. Materials and Methods: Estimates of standard KRAS exon 2 testing were based on the Centers for Medicare and Medicaid Services (CMS) 2014 Diagnostic Laboratory Fee Schedule, and expanded RAS testing was estimated using a sensitivity analysis done with various potential cost scenarios (1, 2, 10, and 30 times the cost of the standard KRAS test). The cost estimates for cetuximab and panitumumab were based on the CMS payment allowance limits for Medicare Part B. Results: A total of 28, 692 patients with metastatic CRC were estimated to be eligible annually for RAS testing. For cetuximab, the societal cost of standard KRAS testing plus the drug versus expanded testing plus the drug would be $1.16 billion versus $816 million if the cost of the tests were the same. If the cost of the expanded RAS test were 30 times the cost of the standard test, then the societal cost of standard KRAS testing plus the drug versus expanded testing plus the drug would be $1.16 billion versus $980 million, a continued savings of more than $184 million annually. Similar savings were seen with panitumumab. Conclusion: The increased societal cost of expanded RAS testing versus standard approved KRAS exon 2 testing was inconsequential when compared with the amount of money saved by not treating the additional 18% of patients who harbor additional RAS mutations (beyond exon 2) with anti‐EGFR therapy. Abstract : This analysis found that the increased cost of expanded RAS testing for metastatic colorectal cancer was small when compared with the amount saved by not treating the additional 18% of patients who harbor additional RAS mutations (beyond exon 2) with anti‐EGFR therapy. Increased use of expanded biomarkers to predict efficacy of targeted agents will provide more precise therapies for patients and reduce the use of potentially ineffective high‐cost therapy.