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postgraduate thesis: Role and cost-effectiveness of biomarker testing in metastatic cancer treatment : policy implications

TitleRole and cost-effectiveness of biomarker testing in metastatic cancer treatment : policy implications
Authors
Issue Date2015
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
Citation
Poon, K. G. [潘家銘]. (2015). Role and cost-effectiveness of biomarker testing in metastatic cancer treatment : policy implications. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b5662739
AbstractBackground Cancer is the top cause of death in Hong Kong and consumes a considerable amount of resources in treatment. The presence of biomarkers as a tool in selecting patients who are likely to benefit from cancer therapy present a challenge to local treatment protocol and policy as there are no specific guideline for biomarker testing. This paper aims to review the evidence of biomarker guided treatment and their cost-effectiveness using lung cancer as an example and recommend appropriate use of these test and relevant policy recommendation for use in cancer treatment. Method A systematic review was done using PubMed for relevant Phase III efficacy trials on Epidermal Growth Factor Receptor (EGFR), Anaplastic Lymphoma Kinase (ALK) mutation in first-line setting and cost-effectiveness studies on testing for these two mutations. Findings For the efficacy review, 9 out of the 10 papers or articles met its efficacy primary endpoint. Progression-free survival (PFS) was the mostly used primary endpoint and all biomarker directed therapy favors longer PFS compared with chemotherapy comparator. None of those studies met the primary endpoint/secondary endpoint in improving overall survival. For the cost-effectiveness testing review, EGFR testing was found to be cost-effective in the Eastern-Asia context. EML4-ALK testing was not cost effective. Conclusion Targeted therapy towards EGFR mutation and EML4-ALK rearrangement was found to improve PFS in patients harboring these genetic abnormalities. Cost-effectiveness analysis show coupling EGFR testing with therapy is a promising approach whereas the test for EML4-ALK rearrangement in all lung cancer patients is not cost-effective. It reminded a policy question to screen for rare mutation like EML4-ALK depending on the ethical perspective taken by the health system. In such case, risk sharing and alternative financing model for rare biomarker can be considered. A reimbursement list for biomarker testing should be in place within Hospital Authority to increase transparency for patients.
DegreeMaster of Public Health
SubjectTumor markers
Cancer - Treatment
Dept/ProgramPublic Health
Persistent Identifierhttp://hdl.handle.net/10722/221863

 

DC FieldValueLanguage
dc.contributor.authorPoon, Ka-ming, Gavin-
dc.contributor.author潘家銘-
dc.date.accessioned2015-12-16T23:18:17Z-
dc.date.available2015-12-16T23:18:17Z-
dc.date.issued2015-
dc.identifier.citationPoon, K. G. [潘家銘]. (2015). Role and cost-effectiveness of biomarker testing in metastatic cancer treatment : policy implications. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b5662739-
dc.identifier.urihttp://hdl.handle.net/10722/221863-
dc.description.abstractBackground Cancer is the top cause of death in Hong Kong and consumes a considerable amount of resources in treatment. The presence of biomarkers as a tool in selecting patients who are likely to benefit from cancer therapy present a challenge to local treatment protocol and policy as there are no specific guideline for biomarker testing. This paper aims to review the evidence of biomarker guided treatment and their cost-effectiveness using lung cancer as an example and recommend appropriate use of these test and relevant policy recommendation for use in cancer treatment. Method A systematic review was done using PubMed for relevant Phase III efficacy trials on Epidermal Growth Factor Receptor (EGFR), Anaplastic Lymphoma Kinase (ALK) mutation in first-line setting and cost-effectiveness studies on testing for these two mutations. Findings For the efficacy review, 9 out of the 10 papers or articles met its efficacy primary endpoint. Progression-free survival (PFS) was the mostly used primary endpoint and all biomarker directed therapy favors longer PFS compared with chemotherapy comparator. None of those studies met the primary endpoint/secondary endpoint in improving overall survival. For the cost-effectiveness testing review, EGFR testing was found to be cost-effective in the Eastern-Asia context. EML4-ALK testing was not cost effective. Conclusion Targeted therapy towards EGFR mutation and EML4-ALK rearrangement was found to improve PFS in patients harboring these genetic abnormalities. Cost-effectiveness analysis show coupling EGFR testing with therapy is a promising approach whereas the test for EML4-ALK rearrangement in all lung cancer patients is not cost-effective. It reminded a policy question to screen for rare mutation like EML4-ALK depending on the ethical perspective taken by the health system. In such case, risk sharing and alternative financing model for rare biomarker can be considered. A reimbursement list for biomarker testing should be in place within Hospital Authority to increase transparency for patients.-
dc.languageeng-
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)-
dc.relation.ispartofHKU Theses Online (HKUTO)-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.-
dc.subject.lcshTumor markers-
dc.subject.lcshCancer - Treatment-
dc.titleRole and cost-effectiveness of biomarker testing in metastatic cancer treatment : policy implications-
dc.typePG_Thesis-
dc.identifier.hkulb5662739-
dc.description.thesisnameMaster of Public Health-
dc.description.thesislevelMaster-
dc.description.thesisdisciplinePublic Health-
dc.description.naturepublished_or_final_version-

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