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Molecular profiling to determine the tissue of origin of a patient’s CUP is not routinely undertaken in the UK – yet it is often a helpful aid to achieving an accurate diagnosis to allow focused treatment with confidence. The NHS need to be convinced of the cost/benefits of molecular profiling for CUP patients.
A Canadian study has investigated the cost-effectiveness of a gene-expression profiling. They built a decision-analytic-model to project the lifetime clinical and economic consequences of different clinical management strategies for CUP. The gene expression based strategy compared to current clinical practice resulted in an incremental cost-effectiveness ratio (ICER) of $44,151 per quality-adjusted life years (QALY) gained. The total annual-budget impact was $36.2 million per year. A value-of-information analysis revealed that the expected value of perfect information about the test’s clinical impact was $4.2 million per year. Their paper in The Pharmacogenomics Journal (2017) 17, 286–300 can be read here.