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Economic analysis of multiple myeloma cancer panel

  • Genomics and economics

Multiple myeloma is diagnosed in over 6,200 new cases each year in the UK, typically in adults over 60, and despite recent advancements in treatments, it remains incurable. Patients at high risk of early relapse and short survival, who may benefit from an intensified first‑line treatment, are currently identified using fluorescent in‑situ hybridisation (FISH) to detect prognostic genetic alterations in the bone marrow. However, FISH does not detect all markers of high‑risk disease, including emerging prognostic alterations that are likely to form part of future diagnostic standards.

A targeted sequencing panel has been developed, which detects a broad range of diagnostic markers. Results from the panel have been shown to alter clinicians’ risk assignment of patients, identifying additional high‑risk patients.

The health economics work aims to determine whether the panel is a cost‑effective alternative to FISH for use in the UK NHS. We performed a microcosting of the panel and found it was slightly less costly per patient than FISH, and was therefore cost‑effective as assessed by cost per additional high‑risk patient detected.

However, the overall cost‑effectiveness of a diagnostic is determined by the resultant treatment decision, and its costs and outcomes. We are therefore also conducting an economic evaluation to determine which test‑treat strategy is the most cost‑effective. As there is no approved cost‑effective intensified treatment currently available in the UK, our model uses a hypothetical, plausible regimen for which we estimate the likely outcomes and costs. Initial results suggest that the difference in the cost of testing is insignificant compared with the cost of treatment. However, the higher detection rate of the panel means more patients are stratified to the more costly, intensified treatment. The analysis will estimate the level of improvement in outcomes that would be required for each test‑treat strategy to be considered cost‑effective.

Funder: National Institute for Healthcare Research Oxford Biomedical Research Centre