Cost-effectiveness of genetic testing in metastatic melanoma patients in the Phase-1 setting.

Vancheswaran Gopalakrishnan, The University of Texas School of Public Health


There is a great interest in delivering personalized cancer care for patients. It has been generally accepted in cancers like CML, and in theory this strategy could even be used in the Phase 1 setting. The value of this strategy will be determined by the increased benefit of the testing against the testing's associated increased costs. My goal in this thesis was to develop a method for determining this value in a cohort of metastatic melanoma patients who participated in phase I clinical trials at M.D. Anderson Cancer Center. The clinical parameter of benefit used was time to treatment failure (TTF) and the charges were those accrued by patients during their participation on the trial. TTF was defined as length of time on a trial without progression. Charge data were extracted from the MD Anderson business data base. In patients where molecular analysis was obtained and used to guide eligibility for targeted phase 1 agents, patients experienced an increase in TTF of 2 months (p=0.099) when compared to patients who were enrolled in a trial without prior molecular analyses. This however was not the primary concern of this study. Using these charges and clinical data, value was determined. The charges added by the testing were of greater influence than was the small, but significant added clinical benefit. Value, not cost alone, ought to be the parameter of importance when determining whether genetic tumor testing will become part of routine clinical care. This methodology is a way to make that determination and can be applied to each individual clinical setting.

Subject Area

Epidemiology|Health care management

Recommended Citation

Gopalakrishnan, Vancheswaran, "Cost-effectiveness of genetic testing in metastatic melanoma patients in the Phase-1 setting." (2013). Texas Medical Center Dissertations (via ProQuest). AAI1549596.