Molecular-profile guided adjuvant treatment shows cost-effectiveness versus standard VBT in HIR-EC
Photo by Vitaly Gariev / Unsplash
Key Takeaway
Consider molecular profiling cost-effective for HIR-EC adjuvant decisions, pending full clinical data.
This phase 3 randomized controlled trial (PORTEC-4a) evaluated the cost-utility of molecular-integrated-risk-profile guided adjuvant treatment compared to standard vaginal brachytherapy (VBT) in 564 women with early-stage (high)intermediate risk endometrial cancer (HIR-EC) across an international setting. The analysis used a three-year follow-up period and a healthcare payer perspective.
Quality-adjusted life-years (QALYs) were comparable between groups (p=0.58). Total healthcare costs were somewhat lower in the molecular-profile arm (€11,898 vs €13,047, p=0.11), driven by significantly lower costs spent up until recurrence (€9,995 vs €11,926, p<0.01). Costs for treatment of recurrence showed no significant difference (€1,903 vs €1,121, p=0.17). At a willingness-to-pay threshold of €20,000 per QALY, the molecular-profile guided strategy was 89% likely to be cost-effective.
Safety and tolerability data were not reported in this cost-utility abstract. Key limitations include that the primary clinical outcome of the PORTEC-4a trial is not specified here, and some cost comparisons did not reach statistical significance. The cost-effectiveness probability is model-based at a specific threshold. The practice relevance is restrained; while these results support implementing molecular profiling, clinicians should await the full trial report detailing primary efficacy and safety outcomes before changing practice.
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View Original Abstract ↓
PURPOSE: The international PORTEC-4a trial demonstrated that individualised adjuvant treatment for women with (high)intermediate risk endometrial cancer (HIR-EC), guided by a molecular-integrated-risk-profile, achieves similar high local tumour control, while nearly half of patients were spared adjuvant treatment. Although determination of the molecular-integrated-profile increases diagnostics costs due to additional immunohistochemistry and DNA-sequencing, these costs may be offset by savings on other care and improved patient outcomes.
PATIENTS AND METHODS: Women with early-stage HIR-EC eligible for the PORTEC-4a trial, were randomised (2:1) to either adjuvant treatment according to their molecular-integrated-profile or standard vaginal brachytherapy (VBT). EC-related costs were evaluated from a healthcare perspective over a three-year follow-up period. Costs were related to quality-adjusted-life-years (QALYs) using the EORTC-QLU-C10D instrument. T-test compared mean QALYs and costs, with multiple imputation for missing data.
RESULTS: All 564 patients were included in the cost-utility-analysis; 367 in molecular-profile arm and 197 in standard arm. QALYs were comparable (p = 0.58). Total healthcare costs were somewhat, but not significantly, lower in molecular-profile arm compared to standard arm (€11,898 vs €13,047, p = 0.11). Costs spent up until recurrence were significantly lower in molecular-profile arm (€9,995 vs €11,926, p < 0.01), while there was no significant difference in treatment for recurrence (€1,903 vs €1,121, p = 0.17). At a willingness-to-pay threshold of €20,000/QALY, the strategy as proposed by PORTEC-4a was 89% likely to be cost-effective.
CONCLUSION: Individualised adjuvant treatment based on a molecular-integrated-profile was more cost-effective than standard VBT for patients with HIR-EC. These results further support the implementation of the molecular-integrated-profile in routine clinical practice.
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