The premarket assessment of the cost-effectiveness of a predictive technology “Straticyte™” for the early detection of oral cancer: a decision analytic model

• Published in: Health economics review Vol. 7; no. 1; p. 35
• Main Authors: Khoudigian-Sinani, S., Blackhouse, G., Levine, M., Thabane, L., O’Reilly, D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 02-10-2017; Springer Nature B.V; BMC
• Subjects: Cost analysis; Cost-effectiveness analysis; Decision analysis; Decision- analytic model; Early detection; Early health technology assessment; Health Care Management; Health Economics; Health Services Research; Histopathology; Medical technology; Medicine; Medicine & Public Health; Oral cancer; Pharmacoeconomics and Health Outcomes; Prognosis; Public Finance; Public Health; Studies; Cost-effectiveness analysis; Histopathology; Prognosis; Early health technology assessment; Decision- analytic model; Early detection
• ISSN: 2191-1991; 2191-1991
• DOI: 10.1186/s13561-017-0170-6

Introduction
Approximately half of oral cancers are detected in advanced stages. The current gold standard is histopathological assessment of biopsied tissue, which is subjective and dependent on expertise.
Straticyte™
, a novel prognostic tool at the pre-market stage, that more accurately identifies patients at high risk for oral cancer than histopathology alone. This study conducts an early cost-effectiveness analysis (CEA) of
Straticyte™
and histopathology versus histopathology alone for oral cancer diagnosis in adult patients.
Methods
A decision-analytic model was constructed after narrowing the scope of
Straticyte™
, and defining application paths. Data was gathered using the belief elicitation method, and systematic review and meta-analysis. The early CEA was conducted from private-payer and patient perspectives, capturing both direct and indirect costs over a five-year time horizon. One-way and probabilistic sensitivity analyses were conducted to investigate uncertainty.
Results
Compared to histopathology alone, histopathology with
Straticyte™
was the dominant strategy, resulting in fewer cancer cases (31 versus 36 per 100 patients) and lower total costs per cancer case avoided (3,360 versus 3,553). This remained robust when
Straticyte™
was applied to moderate and mild cases, but became slightly more expensive but still more effective than histopathology alone when
Straticyte™
was applied to only mild cases. The probabilistic and one-way sensitivity analyses demonstrated that incorporating
Straticyte™
to the current algorithm would be cost-effective over a wide range of parameters and willingness-to-pay values.
Conclusion
This study demonstrates high probability that
Straticyte™
and histopathology will be cost-effective, which encourages continued investment in the product. The analysis is informed by limited clinical data on
Straticyte™
, however as more data becomes available, more precise estimates will be generated.