Economic analysis of epicup, an epigenetic test to predict the tissue of origin in cancer of unknown primary site.

e12532 Background: To estimate the clinical and economic trade-offs involved in using the molecular assay EPICUP to aid in identifying the primary site of difficult-to-diagnose metastatic cancers. Methods: A decision-analytic model was developed to estimate the lifetime clinical and economic outcomes of incorporating the EPICUP assay compared with standard care and other molecular assays (CancerTYPE ID, Cancer Origin Test and ResponseDX Tissue of Origin Test). The analysis was limited to 3 primary cancer sites (breast, colon, pancreatic carcinoma) for adenocarcinoma histological subtype. Results are presented as incremental cost-effectiveness ratio (ICER, cost per quality-adjusted life-years [QALY] gained) from the Spanish National Health System perspective. Model inputs were based on a case-control study of EPICUP, published literature, Surveillance Epidemiology and End Results database, and a panel of clinical experts. Results: Based on a price of €3,000 ($3,391) for EPICUP, this would be the cost-effective ( vs. CancerTYPE ID, Cancer Origin Test) or dominant option (more effective and with lower costs than Response DX) in all carcinomas analyzed. EPICUP increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. Regarding the comparison with standard care, the ICER was €15,882 ($17,958) for breast cancer, €25,858 ($29,393) for colon cancer and €35,374 ($40,199) for pancreatic cancer. These findings were robust across deterministic and probabilistic sensitivity analyses. Conclusions: Use of EPICUP assay for diagnosing metastatic tumors of uncertain origin is a cost-effective approach to standardizing diagnostic methods while improving patient care.