Modelling the Economic Impact of Next Generation Sequencing and Precision Medicine on Childhood Cancer Management—a Microsimulation Approach

Abstract

Precision medicine is a new approach to identify the best treatment available to patients based on their genomic information. However, no economic evaluation of genome sequencinghas been reported for the treatment of childhood cancers, which is critical to evaluate the feasibilityof implementing patient’s genome sequencing as part of a publicly funded treatment strategy. Wehave developed a microsimulation model, PeCanMOD, to evaluate the cost and benefit of applyingthe Next Generation Sequencing (NGS) in the management of childhood cancer. This paper describesthe construction of PeCanMOD. We used linked datasets of children under 18 year of age, living inNew South Wales (NSW), Australia, who have had cancer, as a base population. Their records wereextracted from the NSW Central Cancer Registry and were linked to mortality and hospital datasets.In addition, we simulated the genomic landscape of the cancer registry population, through informationobtained from 1,200 molecularly profiled paediatric cancer from the Foundation Medicine. Themodel simulated the number of individuals eligible for precision medicine, and the incremental costof treatment per life year gained if precision medicine was introduced for late stage cancer patientsas a final treatment option. Cost of drugs, and hospital admission were included in the model. Dataon response rate and probability of survival was imputed based on the latest available evidence. Eachunit record in the model was weighted using input from the Australian Institute of Health and Welfare(AIHW) to reflect total paediatric cancer population in Australia. The model demonstrates the applicationof microsimulation modelling to simulate the impacts of NGS and precision medicine on costsand health outcomes for childhood cancer