To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers.
Methods:
Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost–effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End Results) data, publicly available data, and interviews with clinical experts.
Results:
In all four models, the 92-gene assay increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. In the primary model, the ICER was $50,273/QALY; thus, the 92-gene assay is therefore cost effective when considering a societal willingness-to-pay threshold of $100,000/QALY. These findings were robust across sensitivity analyses.
Conclusions:
Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life. Incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care. Limitations of this analysis are the lack of data availability and resulting modeling simplifications, although sensitivity analyses showed these to not be key drivers of results. 相似文献
AbstractPrevious studies have consistently indicated the important role of emotional experience in decision-making. While both active and passive decision-making coexist in our daily lives, whether and how active and passive decision-making induce different emotional experience remains unclear. In the present research we conduct three studies to examine differences in emotional experience associated with active and passive decisions at multiple levels. First, at the individual level, using both active and passive modes of the Balloon Analog Risk Task in a laboratory behavior study, we demonstrate that active decision-making is associated with more positive emotional experience compared to passive decision-making, including more happiness, less distress, a greater sense of control, and a stronger sense of achievement. Second, at the neural level, we use functional magnetic resonance imaging and find greater activation in the brain’s emotional circuits during active decisions compared to passive decisions, regardless of the decision outcomes. Finally, at the population level, we conduct a large-scale survey to capture the perception of emotional experience during real-world active and passive decisions, and our results confirm that active decisions engender a greater sense of achievement and sense of control and people prefer active decisions to passive decisions. These findings provide valuable insights into the role of emotion experience in decision-making research and practices. 相似文献