Context-Specific Economic Evaluation for Molecular Pathology Tests: An Application in Colorectal Cancer in the West of Scotland

• Published in: International journal of technology assessment in health care Vol. 35; no. 4; pp. 327 - 333
• Main Authors: Bouttell, Janet, Tan, Yun Yi, Creed, David, McGaffin, Gillian, Hawkins, Neil, McLaughlin, Ruth, Smith, Graeme, Westwood, Paul, Williams, Nicola, Graham, Janet
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 2019
• Subjects: Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Assessment; Cancer; Cancer therapies; Case studies; Catheters; Chemotherapy; Clinical outcomes; Clinical trials; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - genetics; Colorectal Neoplasms - pathology; Cost analysis; Cost engineering; Cost-Benefit Analysis; Decision making; Decision trees; Diagnostic systems; Dictionaries; Economic conditions; Economics; Evaluation; Genes; Health; Health services; Humans; Information services; Intervention; Intravenous administration; Medical prognosis; Metastasis; Models, Econometric; Mortality; Mutation; Neoplasm Metastasis; Oncology; Parameter sensitivity; Pathology; Pathology, Molecular - economics; Pathology, Molecular - methods; Patients; Population; Quality-Adjusted Life Years; Scotland; Sensitivity analysis; Sensitivity and Specificity; State Medicine; Systematic review; Technology assessment; Technology Assessment, Biomedical - methods; Tumors; Scotland; United Kingdom > UK; Economic evaluation; Colorectal neoplasms; Genetic testing
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S026646231900045X

The cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources. We established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment. A context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population. The method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.