The influence of patient/provider behavior on the value of ERCC1 testing research in stage II nonsmall cell lung cancer

Joshua A. Roth, Josh J. Carlson, Lotte Steuten, Scott Ramsey, David L. Veenstra

    Research output: Contribution to journalMeeting AbstractAcademic


    Purpose: To assess the value of research for ERCC1 expression testing to inform adjuvant chemotherapy decisions in resected Stage II nonsmall cell lung cancer (NSCLC), given substantial uncertainty about chemotherapy decisions informed by ERCC1 test results.

    Method: We developed a decision-analytic model to estimate the expected value of perfect information (EVPI), perfect parameter information (EVPPI), sample information (EVSI), and sample parameter information (EVSPI) for 2 treatment strategies: 1) ERCC1 testing to inform adjuvant chemotherapy decisions, with ERCC1+ patients indicated to receive no chemotherapy and ERCC1– patients indicated to receive chemotherapy; 2) standard care, with all patients indicated to receive chemotherapy. Thirty percent (range, 10%-50%) of ERCC1+ patients were assumed to not follow test results and choose to receive chemotherapy, and 10% (range 5%-15%) of ERCC1– patients were assumed to not follow test results and choose to not receive chemotherapy. Model parameters and uncertainty ranges were derived from the International Adjuvant Lung Cancer Trial, published literature, and government sources. SEER data were used to calculate the affected population over a 10-year time horizon. A willingness-to-pay threshold of $150000/QALY was used in the base-case.

    Result: The ERCC1 strategy produced greater net-benefit than standard care in 55% of simulations and the average consequence of selecting the wrong strategy was $7400. The EVPI for an affected population of 322,400 was $1.07 B. The EVSI for a trial examining all model parameters with sample sizes of 100, 500, and 1000 patients per arm was $81 M, $847 M, and $1.01 B, respectively. The EVPPI for the chemotherapy utilization behavior parameters was $353 M, and $107 M and $237 M were attributable to ERCC1+ and ERCC1– subgroups, respectively. The EVSPI for a study examining ERCC1+ and ERCC1– chemotherapy utilization behavior was $74 M and $138 M for a sample of 100 patients, and approximately $107 M and $237 M at sample sizes of both 500 and 1,000.

    Conclusion: The value of research greatly exceeded the expected cost of an ERCC1 testing trial, and EVPPI and EVSPI estimates demonstrated the influence of patient/provider behavior on the value of ERCC1 research. These findings demonstrate the overall value of ERCC1 research in NSCLC, identify chemotherapy decision making as a high value research area, and can assist stakeholders in prioritizing funding for ERCC1 research relative to alternative investments.
    Original languageEnglish
    Article numberESP-21
    Pages (from-to)E75-E76
    Number of pages2
    JournalMedical decision making
    Issue number2
    Publication statusPublished - 2011
    Event33rd Annual Meeting of the Society for Medical Decision Making, SMDM 2011: From Evidence to Decision Making: Role of Behavioral Economics in Medicine - Chicago, United States
    Duration: 22 Oct 201126 Oct 2011
    Conference number: 33

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