Precision oncology in advanced cancer patients improves overall survival with lower weekly healthcare costs

Abstract

The impact of precision oncology on guiding treatment decisions of late-stage cancer patients was previously studied in a retrospective analysis. However, the overall survival and costs were not previously evaluated. We report the overall survival and healthcare costs associated with precision oncology in these patients with advanced cancer. Building on a matched cohort study of 44 patients with metastatic cancer who received all of their care within a single institution, we evaluated the overall survival and healthcare costs for each patient. We analyzed the outcomes of 22 patients who received genomic testing and targeted therapy (precision oncology) between July 1, 2013 and January 31, 2015, and compared to 22 historically controlled patients (control) who received standard chemotherapy (N = 17) or best supportive care (N = 5). The median overall survival was 51.7 weeks for the targeted treatment group and 25.8 weeks for the control group (P = 0.008) when matching on age, gender, histological diagnosis and previous treatment lines. Average costs over the entire period were $2,720 per week for the targeted treatment group and $3,453 per week for the control group, (P = 0.036). A separate analysis of 1,814 patients with late-stage cancer diagnoses found that those who received a targeted cancer treatment (N = 93) had 6.9% lower costs in the last 3 months of life compared with those who did not. These findings suggest that precision oncology may improve overall survival for refractory cancer patients while lowering average per-week healthcare costs, resource utilization and end-of-life costs.

Keywords: costs; oncology; outcomes; overall survival; precision medicine.

Figure 1. Overall survival and progression-free survival for patients receiving standard chemotherapy or targeted cancer therapy

Colored boxes indicate lower (green) or higher (red) charge events for each week of treatment. Gray scale areas reflect periods of time during which no charges were generated.

Figure 2. Relative Resource Use (RRU) by site of care for patients receiving standard chemotherapy or targeted cancer therapy

Figure 3. Costs per patient among the health system health plan members in the last 3 months of life, by site of care

Standard Tx: Select Health members with relevant cancer diagnoses who did not receive targeted therapy as part of their treatment course (N = 1,721). Targeted Tx: Select Health members with relevant cancer diagnoses who received targeted therapy as part of their treatment course (N = 93). “All other” includes home health, hospice, and all other sites of care. Only health plan members with relevant cancer Dx and for whom date of death was recorded are included in analysis.