• Home

  • Documents

  • COMPARISON OF UTILITY COST IN THREE COMMERCIALLY …€¦ · COMPARISON OF UTILITY COST IN THREE...
1
COMPARISON OF UTILITY COST IN THREE COMMERCIALLY AVAILABLE PRECISION MEDICINE APPROACHES IN ONCOLOGY Kenneth Russell 1 , Jaak Janssens 2 , Andrew Dean 3 , William Gallagher 4 , Alejandro Hernandez 1 , Andreas Voss 1 , Gordon Stamp 5 1 - Caris Life Sciences, Basel, Switzerland; 2 - Department of Oncology, Limburg Oncology Center, Belgium; 3 - St John of God Hospital, Subiaco, Australia; 4 - UCD School of Biomolecular and Biomedical Science, UCD Conway InsJtute, University College Dublin, Dublin, Ireland; 5 - Imperial College SecJon of InvesJgaJve Medicine, Hammersmith Campus, London, United Kingdom Abstract BACKGROUND: The introduc-on of molecular profiling as standard of care in cancer has led to the launch of a number of commercial precision medicine services, which differ largely in their approaches. It can be difficult for payers, physicians, and pa-ents to dis-nguish between these services and determine which tes-ng is most appropriate for an individual case. An understanding of the clinical u-lity and the u-lity cost (cost of finding one pa-ent with clinical benefit) of the different approaches can help to set expecta-ons for all stakeholders involved. OBJECTIVES: The aim of this study is to define the u-lity cost of three leading commercially available oncology precision medicine approaches, Caris Molecular Intelligence ® (CMI), Founda-onOne ® and PCDx™. METHODS: A systema-c review of all published clinical evidence for the three services was performed, to determine the number of pa-ents treated in line with the profiling results and the clinical benefit resul-ng from these treatment choices. U-lity cost was defined as the list price divided by the frac-on of pa-ents treated based upon the profiling results and the clinical benefit in treated pa-ents. RESULTS: Based on the number of profiled pa-ents treated and the corresponding number of pa-ents with clinical benefit, 34% of CMI-profiled pa-ents had clinical benefit (184 of 534 profiled pa-ents), compared to 6% of those profiled with Founda-onOne ® (166 of 2,675 profiled pa-ents) and 11% profiled using PCDx™ (19 of 168 profiled pa-ents). U-lity cost was calculated as $19,118 for CMI, $43,636 for PCDx™ and $96,667 for Founda-onOne ® . CONCLUSIONS: The results of this study shows that the mul-plaZorm approach of CMI brings the highest clinical u-lity, based on the use of conven-onal chemotherapies in the majority of pa-ents profiled. A low clinical u-lity means that almost 20 cases of Founda-onOne ® must be purchased to find one pa-ent who benefits. Methods – Model for CalculaXon of UXlity Cost • Clinical u-lity is defined as the usefulness of a test for clinical prac-ce and is dis-nct from clinical validity, which is how well the test can determine the presence, absence, or risk of a specific disease. 1 • The model assumes that the clinical u-lity of a molecular profiling approach must demonstrate whether they lead to a reconsidera-on of the treatment plan and whether this improves the clinical outcome in profiled pa-ents. • U-lity cost was defined as the list price divided by the frac-on of pa-ents treated based upon the profiling results and the clinical benefit in treated pa-ents. • The u-lity cost is a reflec-on of the clinical u-lity and indicates the cost needed to treat one pa-ent with clinical benefit. • Sta-s-cal analysis (unpaired t-tests) was performed using GraphPad TM . • List prices for the respec-ve services were based on telephone enquiry or accessed online. 2,3 Results – Graphical RepresentaXon of Clinical UXlity in 100 profiled paXents • In a hypothe-cal popula-on of 100 pa-ents, significantly more pa-ents are treated using CMI compared to FMI (p<0.0001, 95% CI 0.47 to 0.69) or PCDx (p<0.0001; 95% CI 0.39 to 0.63). • There was no significant difference between pa-ents treated when FMI and PCDx were used as the profiling approach (p=0.2380; 955 CI -0.19 to 0.05). • Significantly more pa-ents of the overall cohort profiled experience clinical benefit when using CMI compared to FMI (p<0.0001; 95% CI 0.17 to 0.39) or PCDx (p<0.0001; 95% CI 0.13 to 0.35). • There was no significant difference between levels of profiled pa-ents with clinical benefit when FMI and PCDx were used as the profiling approach (p=0.2995; 95% CI -0.12 to 0.04). Study Highlights – UXlity Cost Differs Between Profiling Approaches • The U-lity Cost (or the cost of profiling per pa-ent tested with clinical benefit) using CMI at $19,118 and is less than a quarter of the equivalent cost of $96,667 using FMI’s NGS only approach and half that of PCDX ($43,636). Results • Seventy-seven percent (411 of 534) of pa-ents profiled with CMI were treated in line with the report. Of these, 88% (365 of 411) were evaluable. Fihy percent of evaluable pa-ents (184 of 365) had clinical benefit. The overall clinical u-lity was 34% (184 of 534 profiled pa-ents). • Nineteen percent (499 of 2,675) of pa-ents profiled using FMI were treated in line with the profiling findings. Of these, 98% (488 of 499) were evaluable. Thirty-four percent of evaluable pa-ents (166 of 488) had clinical benefit. This represents an overall clinical u-lity of 6% (166 of 2,675 profiled pa-ents). • Twenty-six percent (44 of 168) of pa-ents profiled using PCDx were treated in line with the report, of whom all were considered evaluable. Forty-three percent of treated pa-ents had clinical benefit, represen-ng an overall clinical u-lity of 11% (19 of 168 profiled pa-ents). Conclusions • Significantly more pa-ents are treated using CMI’s mul-plaZorm profiling approach, which provides the most comprehensive informa-on (on which chemotherapies, hormone therapies and immunotherapies to use as well as which targeted therapies are suitable) compared to those focused on targeted therapies alone. • The impact on treatment choice is directly dependent on the panel of biomarkers tested, the frequency of those biomarkers in the popula-on and the level of evidence presented to the oncologist in support of a change in treatment decision. • The individual pa-ent’s likelihood of clinical benefit within the whole profiled pa-ent group is the most cri-cal measure for a pa-ent and their oncologist when seing expecta-ons of what a molecular profile can offer. • The cost of profiling does not include any considera-on for the recommended therapies, which would further extend the gap in cost given the high price of targeted therapies compared to conven-onal cytotoxic agents. • The value of profiling should not be considered as a reflec-on of the unit cost but rather the amount that needs to be invested to bring clinical benefit to a single pa-ent. • Precision medicine using a sequencing-only approach brings such low clinical u-lity that the costs seem unsustainable outside of a research seing. References 1. Peabody JW, Shimkada R, Tong KB and Zubiller MB. New Thinking on Clinical U-lity: Hard Lessons for Molecular Diagnos-cs. Am J Manag Care 2014; 20(9): 750 – 756. 2. Accessed online on 16 October 2017 at hrps://assets.contenZul.com/vhribv12lmne/ 5BJHWaCe1Gwu8CaksomGS8/653f19c8657097e43fad4aabbc6495a4/ Pa-ent_Informa-on_Guide_5.pdf 3. Accessed online on 16 October 2017 at hrp://www.paradigmdx.com/wp-content/uploads/2014/08/ParadigmPCDxFAQs4-2014.pdf Background • Molecular tumor profiling for pa-ents with advanced or recurrent solid tumors is increasingly adopted as standard of care in oncology, as it has been demonstrated that improved clinical outcomes can result from selec-on of the op-mal therapy for individual pa-ents. • Ini-al large scale arempts to profile pa-ents in the hope of direc-ng them to molecularly matched clinical trials have highlighted that only a small propor-on of pa-ents have ac-onable altera-ons which are suitable for enrollment into a trial. • For oncologists who are ac-vely integra-ng tumor profiling into their pa-ent’s care today, it can be challenging to understand the differences in clinical u-lity and benefit between numerous available molecular profiling services. The ohen- considerable costs at the pa-ent’s expense require jus-fica-on. • The aim of this study is to to compare and contrast the clinical u-lity of 3 commercial approaches, to show that not all approaches to precision medicine are the same in terms of quality and cost-effec-veness. Methods • Three commercially available services were included in this analysis – Caris Molecular Intelligence ® from Caris Life Sciences, Founda-onOne ® from Roche/ Founda-on medicine, PCDx ™ from Paradigm. • Key differences between molecular profiling services lie in the range and scope of plaZorms used to assess biomarkers. • Caris Molecular Intelligence ® (CMI) – mul-plaZorm profiling service comprised of immunohistochemistry (IHC), next-genera-on sequencing (NGS), RNA sequencing and in situ hybridiza-on (ISH) • Founda-onOne ® (FMI) – NGS only • PCDx™ – Mul-plaZorm service comprised of IHC and NGS • A comprehensive review of all published data was performed for details on number of pa-ents profiled, treated, evaluable and with clinical benefit. • Data from a comparison of commercially available services was based on 534 pa-ents profiled as part of physician-led studies for CMI, 2675 pa-ents profiled using FMI, and 168 pa-ents profiled by PCDx. • It is assumed that pa-ents who are not evaluable did not have clinical benefit. List Price Utility Cost Clinical Utility Impact on Treatment Choice Impact on Patient Outcome Clinical Utility PaXents Profiled PaXents Treated % Impact on Treatment Choice PaXents Evaluable for Clinical Benefit PaXents with clinical Benefit % Clinical Benefit (compared to evaluable pa0ents) % Clinical UXlity (compared to pa0ents profiled) 534 411 77 365 184 50 34 Von Hoff et al. J Clin Oncol (2010) 28(33):4877-4883; Jameson et al. Breast Cancer Res Treat (2014): 147(3):579-588; Dean et al. BioMed Research InternaJonal (2016) doi:10.1155/2016/4627214; Popovtzer et al. BioMed Research InternaJonal (2015) doi:10.1155/2015/614845; Ramanathan et al. Cancer Res (2012)72(8 Suppl): Abstract nr LB-221.; Epelbaum et al. BioMed Research InternaJonal (2015) doi:10.1155/2015/681653.; Purim et al. Journal of Clinical Oncology (2017) 35(15_suppl):e15537.; Seeber et al Genes & Cancer (2016):7(9-10):301-310.; El Ahmadie et al. European Journal of Cancer (2015) 51 (supplement S3): S43.; Chahine et al. Presented at ICACT 2016.; El Nahas et al. Presented at ICACT 2017. 2,675 499 19 488 166 34 6 Ferreira et al. Ann Oncol (2014) 25 (suppl 4): iv560; Ganesan et al. Mol Cancer Ther (2014) 13(12): 3175-84; Brandao Moreira et al. Journal of Clinical Oncology (2015) 33 (28_suppl):133-133; Brandao Moreira et al. Journal of Clinical Oncology (2015) 33 (28_suppl):133-133; Wheler et al. Cancer Res (2016) 76(13):3690-3701; Schwaederle et al. Mol Cancer Ther (2016) 15(4): 743-752; Sohal et al. JNCI J Natl Cancer Inst (2016) 108(3):doi:10.1093/jnci/djv332; Blumenthal et al. J Neurooncol (2016) 130: 211-219; Rodriguez-Rodriguez et al. Gynecologic Oncology (2016) 141(1): 2-9; Johnson et al. The Oncologist (2014) 19:616-622; Hirschfield et al. The Oncologist (2016) 21: 1315-1325; Groisberg et al. Oncotarget (2017) 8:39254-39267; Koenig et al. J Clin Oncol (2016) 34 (suppl; abstr 4100); Dhir et al. Cancer Med (2017) 6(1): 195-206; Yuan et al. Oncotarget (2017) 8(16): 26414-26423; Grenader et al. AnJcancer Drugs (2016) 27(9):899-907; Gunderson et al. Gynecol Oncol (2016) 141(1): 24-28; Groisberg et al. J Clin Oncol 35(15_suppl): 2582; Dalton et al. JCO Precision Oncology (2017) 1: 1-19; Hodeib et al. Gynecologic Oncology (2017) 145(1_suppl): 212; Sicklick et al. J Clin Oncol 35, 2017 (suppl; abstr 2512); Bryce et al. Oncotarget (2017) 8(16): 27145-27154; Braiteh et al. J Clin Oncol (2014) 32:5s(suppl; abstr 11109); DiBardino et al. Clinical Lung Cancer (2016) 17 (6): 517-522; Mantripragada et al. Journal of Oncology PracJce (2016) 12(4):e396-e404 168 44 26 44 19 43 11 Radovich et al. Oncotarget (2016) doi:10.18632/oncotarget.10606 100 100 100 77 19 26 34 6 11 Pa-ents Profiled Pa-ents Treated Pa-ents Treated with Clinical Benefit A B C A B C A B C A B C Intent To Treat = 100 Intent To Treat = 100 Intent To Treat = 100 Treated = 77 Treated = 19 Treated = 26 Treated with Clinical Benefit = 34 Treated with Clinical Benefit = 6 Treated with Clinical Benefit = 11 Service List Price ($) Percentage of PaXents Treated Cost per PaXent Treated ($) Percentage Clinical UXlity UXlity Cost ($) Caris Molecular Intelligence® $6,500 77 $8,442 34 $19,118 FoundaXonOne® $5,800 19 $30,526 6 $96,667 PCDx™ $4,800 26 $18,462 11 $43,636 $6'500 $5'800 $4'800 $8'442 $30'526 $18'462 $19'118 $96'667 $43'636 Cost ($) List Price Cost Per Pa-ent Treated U-lity Cost A B C A B C A B C A B C

COMPARISON OF UTILITY COST IN THREE COMMERCIALLY …€¦ · COMPARISON OF UTILITY COST IN THREE COMMERCIALLY AVAILABLE PRECISION MEDICINE APPROACHES IN ONCOLOGY Kenneth Russell1,

  • Upload
    others

  • View
    2

  • Download
    0

Embed Size (px)

Citation preview

Page 1: COMPARISON OF UTILITY COST IN THREE COMMERCIALLY …€¦ · COMPARISON OF UTILITY COST IN THREE COMMERCIALLY AVAILABLE PRECISION MEDICINE APPROACHES IN ONCOLOGY Kenneth Russell1,

COMPARISONOFUTILITYCOSTINTHREECOMMERCIALLYAVAILABLEPRECISIONMEDICINEAPPROACHESINONCOLOGY

KennethRussell1,JaakJanssens2,AndrewDean3,WilliamGallagher4,AlejandroHernandez1,AndreasVoss1,GordonStamp51-CarisLifeSciences,Basel,Switzerland;2-DepartmentofOncology,LimburgOncologyCenter,Belgium;3-StJohnofGodHospital,Subiaco,Australia;4-UCDSchoolofBiomolecularandBiomedicalScience,UCDConwayInsJtute,UniversityCollegeDublin,Dublin,Ireland;5-ImperialCollegeSecJonofInvesJgaJveMedicine,HammersmithCampus,London,UnitedKingdom

AbstractBACKGROUND:Theintroduc-onofmolecularprofilingasstandardofcareincancerhasledtothelaunchofanumberofcommercialprecisionmedicineservices,whichdifferlargelyintheirapproaches.Itcanbedifficultforpayers,physicians,andpa-entstodis-nguishbetweentheseservicesanddeterminewhichtes-ngismostappropriateforanindividualcase.Anunderstandingoftheclinicalu-lityandtheu-litycost(costoffindingonepa-entwithclinicalbenefit)ofthedifferentapproachescanhelptosetexpecta-onsforallstakeholdersinvolved.OBJECTIVES:Theaimofthisstudyistodefinetheu-litycostofthreeleadingcommerciallyavailableoncologyprecisionmedicineapproaches,CarisMolecularIntelligence®(CMI),Founda-onOne®andPCDx™.METHODS:Asystema-creviewofallpublishedclinicalevidenceforthethreeserviceswasperformed,todeterminethenumberofpa-entstreatedinlinewiththeprofilingresultsandtheclinicalbenefitresul-ngfromthesetreatmentchoices.U-litycostwasdefinedasthelistpricedividedbythefrac-onofpa-entstreatedbasedupontheprofilingresultsandtheclinicalbenefitintreatedpa-ents.RESULTS:Basedonthenumberofprofiledpa-entstreatedandthecorrespondingnumberofpa-entswithclinicalbenefit,34%ofCMI-profiledpa-entshadclinicalbenefit(184of534profiledpa-ents),comparedto6%ofthoseprofiledwithFounda-onOne®(166of2,675profiledpa-ents)and11%profiledusingPCDx™(19of168profiledpa-ents).U-litycostwascalculatedas$19,118forCMI,$43,636forPCDx™and$96,667forFounda-onOne®.CONCLUSIONS:Theresultsofthisstudyshowsthatthemul-plaZormapproachofCMIbringsthehighestclinicalu-lity,basedontheuseofconven-onalchemotherapiesinthemajorityofpa-entsprofiled.Alowclinicalu-litymeansthatalmost20casesofFounda-onOne®mustbepurchasedtofindonepa-entwhobenefits.

Methods–ModelforCalculaXonofUXlityCost•  Clinicalu-lityisdefinedastheusefulnessofatestforclinicalprac-ceandis

dis-nctfromclinicalvalidity,whichishowwellthetestcandeterminethepresence,absence,orriskofaspecificdisease.1

•  Themodelassumesthattheclinicalu-lityofamolecularprofilingapproachmustdemonstratewhethertheyleadtoareconsidera-onofthetreatmentplanandwhetherthisimprovestheclinicaloutcomeinprofiledpa-ents.

•  U-litycostwasdefinedasthelistpricedividedbythefrac-onofpa-entstreatedbasedupontheprofilingresultsandtheclinicalbenefitintreatedpa-ents.

•  Theu-litycostisareflec-onoftheclinicalu-lityandindicatesthecostneededtotreatonepa-entwithclinicalbenefit.

•  Sta-s-calanalysis(unpairedt-tests)wasperformedusingGraphPadTM.•  Listpricesfortherespec-veserviceswerebasedontelephoneenquiryor

accessedonline.2,3

Results–GraphicalRepresentaXonofClinicalUXlityin100profiledpaXents•  Inahypothe-calpopula-onof100pa-ents,significantlymorepa-entsaretreated

usingCMIcomparedtoFMI(p<0.0001,95%CI0.47to0.69)orPCDx(p<0.0001;95%CI0.39to0.63).

•  Therewasnosignificantdifferencebetweenpa-entstreatedwhenFMIandPCDxwereusedastheprofilingapproach(p=0.2380;955CI-0.19to0.05).

•  Significantlymorepa-entsoftheoverallcohortprofiledexperienceclinicalbenefitwhenusingCMIcomparedtoFMI(p<0.0001;95%CI0.17to0.39)orPCDx(p<0.0001;95%CI0.13to0.35).

•  Therewasnosignificantdifferencebetweenlevelsofprofiledpa-entswithclinicalbenefitwhenFMIandPCDxwereusedastheprofilingapproach(p=0.2995;95%CI-0.12to0.04).

StudyHighlights–UXlityCostDiffersBetweenProfilingApproaches•  TheU-lityCost(orthecostofprofilingperpa-enttestedwithclinicalbenefit)

usingCMIat$19,118andislessthanaquarteroftheequivalentcostof$96,667usingFMI’sNGSonlyapproachandhalfthatofPCDX($43,636).

Results•  Seventy-sevenpercent(411of534)ofpa-entsprofiledwithCMIweretreated

inlinewiththereport.Ofthese,88%(365of411)wereevaluable.Fihypercentofevaluablepa-ents(184of365)hadclinicalbenefit.Theoverallclinicalu-litywas34%(184of534profiledpa-ents).

•  Nineteenpercent(499of2,675)ofpa-entsprofiledusingFMIweretreatedinlinewiththeprofilingfindings.Ofthese,98%(488of499)wereevaluable.Thirty-fourpercentofevaluablepa-ents(166of488)hadclinicalbenefit.Thisrepresentsanoverallclinicalu-lityof6%(166of2,675profiledpa-ents).

•  Twenty-sixpercent(44of168)ofpa-entsprofiledusingPCDxweretreatedinlinewiththereport,ofwhomallwereconsideredevaluable.Forty-threepercentoftreatedpa-entshadclinicalbenefit,represen-nganoverallclinicalu-lityof11%(19of168profiledpa-ents).

Conclusions•  Significantlymorepa-entsaretreatedusingCMI’smul-plaZorm

profilingapproach,whichprovidesthemostcomprehensiveinforma-on(onwhichchemotherapies,hormonetherapiesandimmunotherapiestouseaswellaswhichtargetedtherapiesaresuitable)comparedtothosefocusedontargetedtherapiesalone.

•  Theimpactontreatmentchoiceisdirectlydependentonthepanelofbiomarkerstested,thefrequencyofthosebiomarkersinthepopula-onandthelevelofevidencepresentedtotheoncologistinsupportofachangeintreatmentdecision.

•  Theindividualpa-ent’slikelihoodofclinicalbenefitwithinthewholeprofiledpa-entgroupisthemostcri-calmeasureforapa-entandtheironcologistwhenseingexpecta-onsofwhatamolecularprofilecanoffer.

•  Thecostofprofilingdoesnotincludeanyconsidera-onfortherecommendedtherapies,whichwouldfurtherextendthegapincostgiventhehighpriceoftargetedtherapiescomparedtoconven-onalcytotoxicagents.

•  Thevalueofprofilingshouldnotbeconsideredasareflec-onoftheunitcostbutrathertheamountthatneedstobeinvestedtobringclinicalbenefittoasinglepa-ent.

•  Precisionmedicineusingasequencing-onlyapproachbringssuchlowclinicalu-litythatthecostsseemunsustainableoutsideofaresearchseing.

References1.  PeabodyJW,ShimkadaR,TongKBandZubillerMB.NewThinkingonClinicalU-lity:Hard

LessonsforMolecularDiagnos-cs.AmJManagCare2014;20(9):750–756.2.  Accessedonlineon16October2017at

hrps://assets.contenZul.com/vhribv12lmne/5BJHWaCe1Gwu8CaksomGS8/653f19c8657097e43fad4aabbc6495a4/Pa-ent_Informa-on_Guide_5.pdf

3.  Accessedonlineon16October2017athrp://www.paradigmdx.com/wp-content/uploads/2014/08/ParadigmPCDxFAQs4-2014.pdf

Background•  Moleculartumorprofilingforpa-entswithadvancedorrecurrentsolidtumorsisincreasinglyadoptedasstandardofcareinoncology,asithasbeendemonstratedthatimprovedclinicaloutcomescanresultfromselec-onoftheop-maltherapyforindividualpa-ents.

•  Ini-allargescalearemptstoprofilepa-entsinthehopeofdirec-ngthemtomolecularlymatchedclinicaltrialshavehighlightedthatonlyasmallpropor-onofpa-entshaveac-onablealtera-onswhicharesuitableforenrollmentintoatrial.

•  Foroncologistswhoareac-velyintegra-ngtumorprofilingintotheirpa-ent’scaretoday,itcanbechallengingtounderstandthedifferencesinclinicalu-lityandbenefitbetweennumerousavailablemolecularprofilingservices.Theohen-considerablecostsatthepa-ent’sexpenserequirejus-fica-on.

•  Theaimofthisstudyistotocompareandcontrasttheclinicalu-lityof3commercialapproaches,toshowthatnotallapproachestoprecisionmedicinearethesameintermsofqualityandcost-effec-veness.

Methods•  Threecommerciallyavailableserviceswereincludedinthisanalysis–Caris

MolecularIntelligence®fromCarisLifeSciences,Founda-onOne®fromRoche/Founda-onmedicine,PCDx™fromParadigm.

•  KeydifferencesbetweenmolecularprofilingserviceslieintherangeandscopeofplaZormsusedtoassessbiomarkers.

•  CarisMolecularIntelligence®(CMI)–mul-plaZormprofilingservicecomprisedofimmunohistochemistry(IHC),next-genera-onsequencing(NGS),RNAsequencingandinsituhybridiza-on(ISH)

•  Founda-onOne®(FMI)–NGSonly•  PCDx™–Mul-plaZormservicecomprisedofIHCandNGS•  Acomprehensivereviewofallpublisheddatawasperformedfordetailson

numberofpa-entsprofiled,treated,evaluableandwithclinicalbenefit.•  Datafromacomparisonofcommerciallyavailableserviceswasbasedon534

pa-entsprofiledaspartofphysician-ledstudiesforCMI,2675pa-entsprofiledusingFMI,and168pa-entsprofiledbyPCDx.

•  Itisassumedthatpa-entswhoarenotevaluabledidnothaveclinicalbenefit.

List Price

Utility Cost

Clinical Utility

Impact on Treatment Choice

Impact on Patient Outcome

Clinical Utility

PaXentsProfiled

PaXentsTreated

%Impacton

TreatmentChoice

PaXentsEvaluableforClinicalBenefit

PaXentswithclinicalBenefit

%ClinicalBenefit

(comparedtoevaluablepa0ents)

%ClinicalUXlity

(comparedtopa0entsprofiled)

534 411 77 365 184 50 34VonHoffetal.JClinOncol(2010)28(33):4877-4883;Jamesonetal.BreastCancerResTreat(2014):147(3):579-588;Deanetal.BioMedResearchInternaJonal(2016)doi:10.1155/2016/4627214;Popovtzeretal.BioMedResearchInternaJonal(2015)doi:10.1155/2015/614845;Ramanathanetal.CancerRes(2012)72(8Suppl):AbstractnrLB-221.;Epelbaumetal.BioMedResearchInternaJonal(2015)doi:10.1155/2015/681653.;Purimetal.JournalofClinicalOncology(2017)35(15_suppl):e15537.;SeeberetalGenes&Cancer(2016):7(9-10):301-310.;ElAhmadieetal.EuropeanJournalofCancer(2015)51(supplementS3):S43.;Chahineetal.PresentedatICACT2016.;ElNahasetal.PresentedatICACT2017.

2,675 499 19 488 166 34 6Ferreiraetal.AnnOncol(2014)25(suppl4):iv560;Ganesanetal.MolCancerTher(2014)13(12):3175-84;BrandaoMoreiraetal.JournalofClinicalOncology(2015)33(28_suppl):133-133;BrandaoMoreiraetal.JournalofClinicalOncology(2015)33(28_suppl):133-133;Wheleretal.CancerRes(2016)76(13):3690-3701;Schwaederleetal.MolCancerTher(2016)15(4):743-752;Sohaletal.JNCIJNatlCancerInst(2016)108(3):doi:10.1093/jnci/djv332;Blumenthaletal.JNeurooncol(2016)130:211-219;Rodriguez-Rodriguezetal.GynecologicOncology(2016)141(1):2-9;Johnsonetal.TheOncologist(2014)19:616-622;Hirschfieldetal.TheOncologist(2016)21:1315-1325;Groisbergetal.Oncotarget(2017)8:39254-39267;Koenigetal.JClinOncol(2016)34(suppl;abstr4100);Dhiretal.CancerMed(2017)6(1):195-206;Yuanetal.Oncotarget(2017)8(16):26414-26423;Grenaderetal.AnJcancerDrugs(2016)27(9):899-907;Gundersonetal.GynecolOncol(2016)141(1):24-28;Groisbergetal.JClinOncol35(15_suppl):2582;Daltonetal.JCOPrecisionOncology(2017)1:1-19;Hodeibetal.GynecologicOncology(2017)145(1_suppl):212;Sicklicketal.JClinOncol35,2017(suppl;abstr2512);Bryceetal.Oncotarget(2017)8(16):27145-27154;Braitehetal.JClinOncol(2014)32:5s(suppl;abstr11109);DiBardinoetal.ClinicalLungCancer(2016)17(6):517-522;Mantripragadaetal.JournalofOncologyPracJce(2016)12(4):e396-e404

168 44 26 44 19 43 11Radovichetal.Oncotarget(2016)doi:10.18632/oncotarget.10606

100 100 100

77

19

26

34

611

Pa-entsProfiled Pa-entsTreated Pa-entsTreatedwithClinicalBenefit

A B C A B C A B C

A B C

IntentToTreat=100 IntentToTreat=100 IntentToTreat=100

Treated=77

Treated=19

Treated=26

TreatedwithClinicalBenefit=34TreatedwithClinicalBenefit=6

TreatedwithClinicalBenefit=11

ServiceListPrice($)

PercentageofPaXentsTreated

CostperPaXentTreated

($)

PercentageClinicalUXlity

UXlityCost($)

CarisMolecularIntelligence® $6,500 77 $8,442 34 $19,118

FoundaXonOne® $5,800 19 $30,526 6 $96,667

PCDx™ $4,800 26 $18,462 11 $43,636

$6'500 $5'800 $4'800$8'442

$30'526

$18'462$19'118

$96'667

$43'636Cost($

)

ListPrice

CostPerPa-entTreated

U-lityCost

A B C A B C A B C

A

B

C

Carsolize - commercially driven travel technology

Carsolize - commercially driven travel technology

Documents
(2)Commercially Available Biosensors_Matthew

(2)Commercially Available Biosensors_Matthew

Documents
Solar Fuel for a Clean Planet. Who is Solel? A technology company, providing a one-stop solution for utility scale solar fields The only commercially

Solar Fuel for a Clean Planet. Who is Solel? A technology company, providing a one-stop solution for utility scale solar fields The only commercially

Documents
Commercially Harvested Macropods 2018-22

Commercially Harvested Macropods 2018-22

Documents
Commercially Important Medicinal & Aromatic Plants

Commercially Important Medicinal & Aromatic Plants

Documents
 · 2011-12-21 · Please contact us for detailed information regarding specific applications. ... • Commercially accepted in the utility and refinery marketplace ... of pressure-related

 · 2011-12-21 · Please contact us for detailed information regarding specific applications. ... • Commercially accepted in the utility and refinery marketplace ... of pressure-related

Documents
MySQL Enterprise Backup User's Guide (Version 8.0.18) · Abstract This is the user manual for MySQL Enterprise Backup, a commercially licensed backup utility for MySQL databases

MySQL Enterprise Backup User's Guide (Version 8.0.18) · Abstract This is the user manual for MySQL Enterprise Backup, a commercially licensed backup utility for MySQL databases

Documents
Developing Commercially Viable Infrastructure Projects

Developing Commercially Viable Infrastructure Projects

Documents
How is sugar obtained commercially?

How is sugar obtained commercially?

Documents
MySQL Enterprise Backup User's Guide (Version 4.0.3)...Abstract This is the user manual for MySQL Enterprise Backup, a commercially licensed backup utility for MySQL databases. It

MySQL Enterprise Backup User's Guide (Version 4.0.3)...Abstract This is the user manual for MySQL Enterprise Backup, a commercially licensed backup utility for MySQL databases. It

Documents
Going Green Commercially Part 4d

Going Green Commercially Part 4d

Business
Yearwise list of commercially released varieties ofBt ...geacindia.gov.in/resource-documents/approved-products/Final_commercially_approved.pdfYearwise list of commercially released

Yearwise list of commercially released varieties ofBt ...geacindia.gov.in/resource-documents/approved-products/Final_commercially_approved.pdfYearwise list of commercially released

Documents
Commercially Important Cra

Commercially Important Cra

Documents
MAKING JAM COMMERCIALLY - PRINCIPLES, METHODS, …

MAKING JAM COMMERCIALLY - PRINCIPLES, METHODS, …

Documents
Radioactivity in commercially available metals

Radioactivity in commercially available metals

Documents
Operational characteristics of commercially available

Operational characteristics of commercially available

Documents
Transparency and commercially - European Medicines Agency€¦ · Concept of “commercially confidential” info “Principles to be applied for the Deletion of Commercially Confidential

Transparency and commercially - European Medicines Agency€¦ · Concept of “commercially confidential” info “Principles to be applied for the Deletion of Commercially Confidential

Documents
Identifying potentially commercially disruptive technologies · Identifying potentially commercially disruptive technologies Peter Evans peter.evans@ipo.gov.uk Senior Analyst

Identifying potentially commercially disruptive technologies · Identifying potentially commercially disruptive technologies Peter Evans [email protected] Senior Analyst

Documents
Logicist responses to Kant: (early) Frege and (early) Russell1 · Logicist responses to Kant: (early) Frege and (early) Russell1 ... Later, the idea was defended in much greater detail

Logicist responses to Kant: (early) Frege and (early) Russell1 · Logicist responses to Kant: (early) Frege and (early) Russell1 ... Later, the idea was defended in much greater detail

Documents
Commercially Available Fiber Optic Cables

Commercially Available Fiber Optic Cables

Education
Revisiting the Connection between African Easterly Waves ... · Revisiting the Connection between African Easterly Waves and Atlantic Tropical Cyclogenesis James Russell1, AnanthaAiyyer1,

Revisiting the Connection between African Easterly Waves ... · Revisiting the Connection between African Easterly Waves and Atlantic Tropical Cyclogenesis James Russell1, AnanthaAiyyer1,

Documents
LAN Control Utility User Manual Contents · available LAN cable or wireless LAN adapter. When connecting multiple projectors, use a commercially available hub. • A LAN terminal

LAN Control Utility User Manual Contents · available LAN cable or wireless LAN adapter. When connecting multiple projectors, use a commercially available hub. • A LAN terminal

Documents
METAL CONTAMINATION IN COMMERCIALLY IMPORTANT FISH …eprints.usm.my/.../1/Metal_contamination_in_commercially_important_fish...metal contamination in commercially important fish and

METAL CONTAMINATION IN COMMERCIALLY IMPORTANT FISH …eprints.usm.my/.../1/Metal_contamination_in_commercially_important_fish...metal contamination in commercially important fish and

Documents
Organisation Information Document – Non-Commercially ... documents/Organisatio…  · Web viewOrganisation Information Document – Non-Commercially Sponsored Studies (Template

Organisation Information Document – Non-Commercially ... documents/Organisatio…  · Web viewOrganisation Information Document – Non-Commercially Sponsored Studies (Template

Documents
Sucrose as a Gelation Inhibitor of Commercially Frozen ... · Sucrose as a Gelation Inhibitor of Commercially Frozen Papaya Puree ... Sucrose as a Gelation Inhibitor of Commercially

Sucrose as a Gelation Inhibitor of Commercially Frozen ... · Sucrose as a Gelation Inhibitor of Commercially Frozen Papaya Puree ... Sucrose as a Gelation Inhibitor of Commercially

Documents
Growing Mushrooms Commercially —

Growing Mushrooms Commercially —

Documents
A Commercially Based Lunar Architecture

A Commercially Based Lunar Architecture

Documents
Going Green Commercially Part 4c

Going Green Commercially Part 4c

Business
Commercially Effective MCM

Commercially Effective MCM

Documents
Commercially confidential

Commercially confidential

Documents