Dissertations and Theses
Improving Medicare & Medicaid Reimbursement Framework for Molecular Diagnostics Tests Using Gene Sequencing: A Case Study in Health Economics
Date of Award
Economics and Business
Dr. Prabal De
Dr. Kevin Foster
Breast cancer, Herceptin, CMS
Breast cancer is the second leading cause of deaths among women, as about one in eight women in the US will develop invasive breast cancer during their lifetime. After the diagnosis of breast cancer, chemotherapy is the commonly prescribed first line of treatment. In the recent past, research has shown that molecular diagnostic tests have revealed that about 20% of the tumors carry the HER-2 mutation on cell surface, which can be treated with the drug Herceptin, or trastuzumab, improving cancer free survival rates from 71.9% to 84.2% in five years. However, in spite of the observed increase in survival rates, the question of economic value produced by adding Herceptin to the chemotherapy remains an open question. We developed a model to analyze the economic benefits of using molecular diagnostics to reveal actionable clinical alterations. We used cancer registry incidence data from the Surveillance, Epidemiology, and End Results (SEER) program to compare the incidence rates and survival years per patient in a broad population. The results were incorporated into an economic model to predict benefits derived, in terms of cost savings, by the breast cancer patients. Specifically, we projected per patient life years saved by adding Herceptin to the chemotherapy. Using conservative estimates for the dollar value of each life year saved, which stands at $100,000 in 2016 dollars, total savings from adding Herceptin to chemotherapy were $36,925 per patient. Even stretching the cost estimates does not change the general results. This model, which can objectively compare two therapy regimes in terms of economic benefits derived by stakeholders, can be applied to evaluate the economic value of competing treatment regimes.
Apte, Advait, "Improving Medicare & Medicaid Reimbursement Framework for Molecular Diagnostics Tests Using Gene Sequencing: A Case Study in Health Economics" (2016). CUNY Academic Works.