IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0085897.html
   My bibliography  Save this article

KRAS Early Testing: Consensus Initiative and Cost-Effectiveness Evaluation for Metastatic Colorectal Patients in an Italian Setting

Author

Listed:
  • Carlo Barone
  • Carmine Pinto
  • Nicola Normanno
  • Lorenzo Capussotti
  • Francesco Cognetti
  • Alfredo Falcone
  • Lorenzo Mantovani

Abstract

KRAS testing is relevant for the choice of the most appropriate first-line therapy of metastatic colorectal cancer (CRC). Strategies for preventing unequal access to the test should be implemented, but their relevance in the practice is related to economic sustainability. The study adopted the Delphi technique to reach a consensus on several topics. Issues related to execution of KRAS testing were identified by an expert’s board and proposed to 108 Italian oncologists and pathologists through two subsequent questionnaires. The emerging proposal was evaluated by decision analyses models employed by technology assessment agencies in order to assess cost-effectiveness. Alternative therapeutic strategies included most commonly used chemotherapy regimens alone or in combination with cetuximab or bevacizumab. The survey indicated that time interval for obtaining KRAS test should not exceed 15 days, 10 days being an optimal interval. To assure the access to proper treatment, a useful strategy should be to anticipate the test after radical resection in patients at high risk of relapse. Early KRAS testing in high risk CRC patients generates incremental cost-effectiveness ratios between 6,000 and 13,000 Euro per quality adjusted life year (QALY) gained. In extensive sensitivity analyses ICER’s were always below 15,000 Euro per QALY gained, far within the threshold of 60,000 Euro/QALY gained accepted by regulatory institutions in Italy. In metastatic CRC a time interval higher than 15 days for result of KRAS testing limits access to therapeutic choices. Anticipating KRAS testing before the onset of metastatic disease in patients at high risk does not affect the sustainability and cost-effectiveness profile of cetuximab in first-line mCRC. Early KRAS testing may prevent this inequality in high-risk patients, whether they develop metastases, and is a cost-effective strategy. Based on these results, present joined recommendations of Italian societies of Oncology and Pathology should be updated including early KRAS testing.

Suggested Citation

  • Carlo Barone & Carmine Pinto & Nicola Normanno & Lorenzo Capussotti & Francesco Cognetti & Alfredo Falcone & Lorenzo Mantovani, 2014. "KRAS Early Testing: Consensus Initiative and Cost-Effectiveness Evaluation for Metastatic Colorectal Patients in an Italian Setting," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-13, January.
    • Handle: RePEc:plo:pone00:0085897
    DOI: 10.1371/journal.pone.0085897
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0085897
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0085897&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0085897?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Rowe, Gene & Wright, George, 1999. "The Delphi technique as a forecasting tool: issues and analysis," International Journal of Forecasting, Elsevier, vol. 15(4), pages 353-375, October.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Stuart J. Wright & William G. Newman & Katherine Payne, 2019. "Accounting for Capacity Constraints in Economic Evaluations of Precision Medicine: A Systematic Review," PharmacoEconomics, Springer, vol. 37(8), pages 1011-1027, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Prommer, Lisa & Tiberius, Victor & Kraus, Sascha, 2020. "Exploring the future of startup leadership development," Journal of Business Venturing Insights, Elsevier, vol. 14(C).
    2. Bas Kolen & Matthijs Kok & Ira Helsloot & Bob Maaskant, 2013. "EvacuAid: A Probabilistic Model to Determine the Expected Loss of Life for Different Mass Evacuation Strategies During Flood Threats," Risk Analysis, John Wiley & Sons, vol. 33(7), pages 1312-1333, July.
    3. Meissner, Philip & Brands, Christian & Wulf, Torsten, 2017. "Quantifiying blind spots and weak signals in executive judgment: A structured integration of expert judgment into the scenario development process," International Journal of Forecasting, Elsevier, vol. 33(1), pages 244-253.
    4. Fabio Salamanca-Buentello & Mary V Seeman & Abdallah S Daar & Ross E G Upshur, 2020. "The ethical, social, and cultural dimensions of screening for mental health in children and adolescents of the developing world," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-25, August.
    5. Prianto Budi Saptono & Gustofan Mahmud & Intan Pratiwi & Dwi Purwanto & Ismail Khozen & Muhamad Akbar Aditama & Siti Khodijah & Maria Eurelia Wayan & Rina Yuliastuty Asmara & Ferry Jie, 2023. "Development of Climate-Related Disclosure Indicators for Application in Indonesia: A Delphi Method Study," Sustainability, MDPI, vol. 15(14), pages 1-25, July.
    6. Heiskanen, Aleksi & Hurmekoski, Elias & Toppinen, Anne & Näyhä, Annukka, 2022. "Exploring the unknowns – State of the art in qualitative forest-based sector foresight research," Forest Policy and Economics, Elsevier, vol. 135(C).
    7. Lin, Tun & De Guzman, Franklin, 2007. "Tourism for pro-poor and sustainable growth: economic analysis of tourism projects," MPRA Paper 24994, University Library of Munich, Germany.
    8. Di Zio, Simone & Bolzan, Mario & Marozzi, Marco, 2021. "Classification of Delphi outputs through robust ranking and fuzzy clustering for Delphi-based scenarios," Technological Forecasting and Social Change, Elsevier, vol. 173(C).
    9. Litsiou, Konstantia & Polychronakis, Yiannis & Karami, Azhdar & Nikolopoulos, Konstantinos, 2022. "Relative performance of judgmental methods for forecasting the success of megaprojects," International Journal of Forecasting, Elsevier, vol. 38(3), pages 1185-1196.
    10. Philip Rogiers & Stijn Viaene & Jan Leysen, 2020. "The digital future of internal staffing: A vision for transformational electronic human resource management," Intelligent Systems in Accounting, Finance and Management, John Wiley & Sons, Ltd., vol. 27(4), pages 182-196, October.
    11. Yaniv, Ilan, 2011. "Group diversity and decision quality: Amplification and attenuation of the framing effect," International Journal of Forecasting, Elsevier, vol. 27(1), pages 41-49.
    12. Alyami, Saleh. H. & Rezgui, Yacine & Kwan, Alan, 2013. "Developing sustainable building assessment scheme for Saudi Arabia: Delphi consultation approach," Renewable and Sustainable Energy Reviews, Elsevier, vol. 27(C), pages 43-54.
    13. Arkadiusz Wisniowski & Nico Keilman & Jakub Bijak & Solveig Christiansen & Jonathan J. Forster & Peter W.F Smith & James Raymer, 2012. "Augmenting migration statistics with expert knowledge," Norface Discussion Paper Series 2012005, Norface Research Programme on Migration, Department of Economics, University College London.
    14. Ngoy Kabemba S. & Mwiya Balimu & Mwanaumo Erastus & Chisumbe Sampa & Petere Gaida, 2023. "Factors Influencing Professional Indemnity Insurance Use in Construction Risk Management," Baltic Journal of Real Estate Economics and Construction Management, Sciendo, vol. 11(1), pages 199-220, January.
    15. van Asselt, E.D. & Meuwissen, M.P.M. & van Asseldonk, M.A.P.M. & Sterrenburg, P. & Mengelers, M.J.B. & van der Fels-Klerx, H.J., 2011. "Approach for a pro-active emerging risk system on biofuel by-products in feed," Food Policy, Elsevier, vol. 36(3), pages 421-429, June.
    16. Makkonen, Mari & Pätäri, Satu & Jantunen, Ari & Viljainen, Satu, 2012. "Competition in the European electricity markets – outcomes of a Delphi study," Energy Policy, Elsevier, vol. 44(C), pages 431-440.
    17. Georg Aichholzer, 2002. "Das ExpertInnen-Delphi: methodische Grundlagen und Anwendungsfeld ‘Technology Foresight‘ (The Expert Delphi: Methodology and Application in 'Technology Foresight')," ITA manu:scripts 02_01, Institute of Technology Assessment (ITA).
    18. Hayes, Tom, 2007. "Delphi study of the future of marketing of higher education," Journal of Business Research, Elsevier, vol. 60(9), pages 927-931, September.
    19. Ying Zhou & Weiwei Li & Pingtao Yi & Chengju Gong, 2019. "Evaluation of City Sustainability from the Perspective of Behavioral Guidance," Sustainability, MDPI, vol. 11(23), pages 1-17, November.
    20. Daniel Reißmann & Daniela Thrän & Alberto Bezama, 2018. "Key Development Factors of Hydrothermal Processes in Germany by 2030: A Fuzzy Logic Analysis," Energies, MDPI, vol. 11(12), pages 1-20, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0085897. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.