Implementing precision cancer medicine in the public health services of Norway: The diagnostic infrastructure and a cost estimate

Anne Hansen Ree, Hege G. Russnes, Daniel Heinrich, Svein Dueland, Kjetil Boye, Vigdis Nygaard, Laxmi Silwal-Pandit, Olga Østrup, Eivind Hovig, Vegard Nygaard, Einar A. Rødland, Sigve Nakken, Janne T. Øien, Christin Johansen, Inger R. Bergheim, Veronica Skarpeteig, Menaka Sathermugathevan, Torill Sauer, Marius Lund-Iversen, Klaus BeiskeSalah Nasser, Lars Julsrud, Claudius H. Reisse, Espen A. Ruud, Vivi Ann Flørenes, Kirsten T. Hagene, Eline Aas, Hilde Lurås, Siv Johnsen-Soriano, Gry A. Geitvik, Ole Christian Lingjærde, Anne Lise Børresen-Dale, Gunhild M. Mælandsmo, Kjersti Flatmark

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Through the conduct of an individual-based intervention study, the main purpose of this project was to build and evaluate the required infrastructure that may enable routine practice of precision cancer medicine in the public health services of Norway, including modelling of costs. Methods An eligible patient had end-stage metastatic disease from a solid tumour. Metastatic tissue was analysed by DNA sequencing, using a 50-gene panel and a study-generated pipeline for analysis of sequence data, supplemented with fluorescence in situ hybridisation to cover relevant biomarkers. Cost estimations compared best supportive care, biomarker-agnostic treatment with a molecularly targeted agent and biomarker-based treatment with such a drug. These included costs for medication, outpatient clinic visits, admission from adverse events and the biomarker-based procedures. Results The diagnostic procedures, which comprised sampling of metastatic tissue, mutation analysis and data interpretation at the Molecular Tumor Board before integration with clinical data at the Clinical Tumor Board, were completed in median 18 (8-39) days for the 22 study patients. The 23 invasive procedures (12 from liver, 6 from lung, 5 from other sites) caused a single adverse event (pneumothorax). Per patient, 0-5 mutations were detected in metastatic tumours; however, no actionable target case was identified for the current single-agent therapy approach. Based on the cost modelling, the biomarker-based approach was 2.5-fold more costly than best supportive care and 2.5-fold less costly than the biomarker-agnostic option. Conclusions The first project phase established a comprehensive diagnostic infrastructure for precision cancer medicine, which enabled expedite and safe mutation profiling of metastatic tumours and data interpretation at multidisciplinary tumour boards for patients with end-stage cancer. Furthermore, it prepared for protocol amendments, recently approved by the designated authorities for the second study phase, allowing more comprehensive mutation analysis and opportunities to define therapy targets.

Original languageEnglish (US)
Article numbere000158
JournalESMO Open
Volume2
Issue number2
DOIs
StatePublished - Jun 2017

Fingerprint

Precision Medicine
United States Public Health Service
Norway
Costs and Cost Analysis
Biomarkers
Neoplasms
Mutation
Pneumothorax
Therapeutics
Ambulatory Care
Ambulatory Care Facilities
Fluorescence In Situ Hybridization
DNA Sequence Analysis
Sequence Analysis
Lung
Liver

Keywords

  • cost model
  • metastasis
  • molecularly targeted therapy
  • mutation profiling
  • public health services

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Implementing precision cancer medicine in the public health services of Norway : The diagnostic infrastructure and a cost estimate. / Ree, Anne Hansen; Russnes, Hege G.; Heinrich, Daniel; Dueland, Svein; Boye, Kjetil; Nygaard, Vigdis; Silwal-Pandit, Laxmi; Østrup, Olga; Hovig, Eivind; Nygaard, Vegard; Rødland, Einar A.; Nakken, Sigve; Øien, Janne T.; Johansen, Christin; Bergheim, Inger R.; Skarpeteig, Veronica; Sathermugathevan, Menaka; Sauer, Torill; Lund-Iversen, Marius; Beiske, Klaus; Nasser, Salah; Julsrud, Lars; Reisse, Claudius H.; Ruud, Espen A.; Flørenes, Vivi Ann; Hagene, Kirsten T.; Aas, Eline; Lurås, Hilde; Johnsen-Soriano, Siv; Geitvik, Gry A.; Lingjærde, Ole Christian; Børresen-Dale, Anne Lise; Mælandsmo, Gunhild M.; Flatmark, Kjersti.

In: ESMO Open, Vol. 2, No. 2, e000158, 06.2017.

Research output: Contribution to journalArticle

Ree, AH, Russnes, HG, Heinrich, D, Dueland, S, Boye, K, Nygaard, V, Silwal-Pandit, L, Østrup, O, Hovig, E, Nygaard, V, Rødland, EA, Nakken, S, Øien, JT, Johansen, C, Bergheim, IR, Skarpeteig, V, Sathermugathevan, M, Sauer, T, Lund-Iversen, M, Beiske, K, Nasser, S, Julsrud, L, Reisse, CH, Ruud, EA, Flørenes, VA, Hagene, KT, Aas, E, Lurås, H, Johnsen-Soriano, S, Geitvik, GA, Lingjærde, OC, Børresen-Dale, AL, Mælandsmo, GM & Flatmark, K 2017, 'Implementing precision cancer medicine in the public health services of Norway: The diagnostic infrastructure and a cost estimate', ESMO Open, vol. 2, no. 2, e000158. https://doi.org/10.1136/esmoopen-2017-000158
Ree, Anne Hansen ; Russnes, Hege G. ; Heinrich, Daniel ; Dueland, Svein ; Boye, Kjetil ; Nygaard, Vigdis ; Silwal-Pandit, Laxmi ; Østrup, Olga ; Hovig, Eivind ; Nygaard, Vegard ; Rødland, Einar A. ; Nakken, Sigve ; Øien, Janne T. ; Johansen, Christin ; Bergheim, Inger R. ; Skarpeteig, Veronica ; Sathermugathevan, Menaka ; Sauer, Torill ; Lund-Iversen, Marius ; Beiske, Klaus ; Nasser, Salah ; Julsrud, Lars ; Reisse, Claudius H. ; Ruud, Espen A. ; Flørenes, Vivi Ann ; Hagene, Kirsten T. ; Aas, Eline ; Lurås, Hilde ; Johnsen-Soriano, Siv ; Geitvik, Gry A. ; Lingjærde, Ole Christian ; Børresen-Dale, Anne Lise ; Mælandsmo, Gunhild M. ; Flatmark, Kjersti. / Implementing precision cancer medicine in the public health services of Norway : The diagnostic infrastructure and a cost estimate. In: ESMO Open. 2017 ; Vol. 2, No. 2.
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abstract = "Objective Through the conduct of an individual-based intervention study, the main purpose of this project was to build and evaluate the required infrastructure that may enable routine practice of precision cancer medicine in the public health services of Norway, including modelling of costs. Methods An eligible patient had end-stage metastatic disease from a solid tumour. Metastatic tissue was analysed by DNA sequencing, using a 50-gene panel and a study-generated pipeline for analysis of sequence data, supplemented with fluorescence in situ hybridisation to cover relevant biomarkers. Cost estimations compared best supportive care, biomarker-agnostic treatment with a molecularly targeted agent and biomarker-based treatment with such a drug. These included costs for medication, outpatient clinic visits, admission from adverse events and the biomarker-based procedures. Results The diagnostic procedures, which comprised sampling of metastatic tissue, mutation analysis and data interpretation at the Molecular Tumor Board before integration with clinical data at the Clinical Tumor Board, were completed in median 18 (8-39) days for the 22 study patients. The 23 invasive procedures (12 from liver, 6 from lung, 5 from other sites) caused a single adverse event (pneumothorax). Per patient, 0-5 mutations were detected in metastatic tumours; however, no actionable target case was identified for the current single-agent therapy approach. Based on the cost modelling, the biomarker-based approach was 2.5-fold more costly than best supportive care and 2.5-fold less costly than the biomarker-agnostic option. Conclusions The first project phase established a comprehensive diagnostic infrastructure for precision cancer medicine, which enabled expedite and safe mutation profiling of metastatic tumours and data interpretation at multidisciplinary tumour boards for patients with end-stage cancer. Furthermore, it prepared for protocol amendments, recently approved by the designated authorities for the second study phase, allowing more comprehensive mutation analysis and opportunities to define therapy targets.",
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T1 - Implementing precision cancer medicine in the public health services of Norway

T2 - The diagnostic infrastructure and a cost estimate

AU - Ree, Anne Hansen

AU - Russnes, Hege G.

AU - Heinrich, Daniel

AU - Dueland, Svein

AU - Boye, Kjetil

AU - Nygaard, Vigdis

AU - Silwal-Pandit, Laxmi

AU - Østrup, Olga

AU - Hovig, Eivind

AU - Nygaard, Vegard

AU - Rødland, Einar A.

AU - Nakken, Sigve

AU - Øien, Janne T.

AU - Johansen, Christin

AU - Bergheim, Inger R.

AU - Skarpeteig, Veronica

AU - Sathermugathevan, Menaka

AU - Sauer, Torill

AU - Lund-Iversen, Marius

AU - Beiske, Klaus

AU - Nasser, Salah

AU - Julsrud, Lars

AU - Reisse, Claudius H.

AU - Ruud, Espen A.

AU - Flørenes, Vivi Ann

AU - Hagene, Kirsten T.

AU - Aas, Eline

AU - Lurås, Hilde

AU - Johnsen-Soriano, Siv

AU - Geitvik, Gry A.

AU - Lingjærde, Ole Christian

AU - Børresen-Dale, Anne Lise

AU - Mælandsmo, Gunhild M.

AU - Flatmark, Kjersti

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N2 - Objective Through the conduct of an individual-based intervention study, the main purpose of this project was to build and evaluate the required infrastructure that may enable routine practice of precision cancer medicine in the public health services of Norway, including modelling of costs. Methods An eligible patient had end-stage metastatic disease from a solid tumour. Metastatic tissue was analysed by DNA sequencing, using a 50-gene panel and a study-generated pipeline for analysis of sequence data, supplemented with fluorescence in situ hybridisation to cover relevant biomarkers. Cost estimations compared best supportive care, biomarker-agnostic treatment with a molecularly targeted agent and biomarker-based treatment with such a drug. These included costs for medication, outpatient clinic visits, admission from adverse events and the biomarker-based procedures. Results The diagnostic procedures, which comprised sampling of metastatic tissue, mutation analysis and data interpretation at the Molecular Tumor Board before integration with clinical data at the Clinical Tumor Board, were completed in median 18 (8-39) days for the 22 study patients. The 23 invasive procedures (12 from liver, 6 from lung, 5 from other sites) caused a single adverse event (pneumothorax). Per patient, 0-5 mutations were detected in metastatic tumours; however, no actionable target case was identified for the current single-agent therapy approach. Based on the cost modelling, the biomarker-based approach was 2.5-fold more costly than best supportive care and 2.5-fold less costly than the biomarker-agnostic option. Conclusions The first project phase established a comprehensive diagnostic infrastructure for precision cancer medicine, which enabled expedite and safe mutation profiling of metastatic tumours and data interpretation at multidisciplinary tumour boards for patients with end-stage cancer. Furthermore, it prepared for protocol amendments, recently approved by the designated authorities for the second study phase, allowing more comprehensive mutation analysis and opportunities to define therapy targets.

AB - Objective Through the conduct of an individual-based intervention study, the main purpose of this project was to build and evaluate the required infrastructure that may enable routine practice of precision cancer medicine in the public health services of Norway, including modelling of costs. Methods An eligible patient had end-stage metastatic disease from a solid tumour. Metastatic tissue was analysed by DNA sequencing, using a 50-gene panel and a study-generated pipeline for analysis of sequence data, supplemented with fluorescence in situ hybridisation to cover relevant biomarkers. Cost estimations compared best supportive care, biomarker-agnostic treatment with a molecularly targeted agent and biomarker-based treatment with such a drug. These included costs for medication, outpatient clinic visits, admission from adverse events and the biomarker-based procedures. Results The diagnostic procedures, which comprised sampling of metastatic tissue, mutation analysis and data interpretation at the Molecular Tumor Board before integration with clinical data at the Clinical Tumor Board, were completed in median 18 (8-39) days for the 22 study patients. The 23 invasive procedures (12 from liver, 6 from lung, 5 from other sites) caused a single adverse event (pneumothorax). Per patient, 0-5 mutations were detected in metastatic tumours; however, no actionable target case was identified for the current single-agent therapy approach. Based on the cost modelling, the biomarker-based approach was 2.5-fold more costly than best supportive care and 2.5-fold less costly than the biomarker-agnostic option. Conclusions The first project phase established a comprehensive diagnostic infrastructure for precision cancer medicine, which enabled expedite and safe mutation profiling of metastatic tumours and data interpretation at multidisciplinary tumour boards for patients with end-stage cancer. Furthermore, it prepared for protocol amendments, recently approved by the designated authorities for the second study phase, allowing more comprehensive mutation analysis and opportunities to define therapy targets.

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KW - public health services

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