Cost-Effectiveness of Multiplexed Predictive Biomarker Screening in Non-Small-Cell Lung Cancer. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Romanus, Dorothy; Cardarella, Stephanie; Cutler, David; Landrum, Mary Beth; Lindeman, Neal I.; Gazelle, G. Scott
• Is Part Of: Journal of thoracic oncology. Volume 10:Issue 4(2015)
• Publication Date: 2015-04
• Subjects: Multiplexed test -- Non-small-cell -- Lung cancer -- Targeted therapy -- Cost-effectiveness; Chest -- Cancer -- Periodicals; Thoracic Neoplasms -- Periodicals; 616.99494005
• DOI: 10.1097/JTO.0000000000000474
• Languages: English
• ISSNs: 1556-0864

Abstract

Abstract : Introduction: Population-wide screening for epidermal growth factor receptor ( EGFR ) mutations and anaplastic lymphoma kinase ( ALK ) gene rearrangements to inform cancer therapy in non-small-cell lung cancer (NSCLC) is recommended by guidelines. We estimated cost-effectiveness of multiplexed predictive biomarker screening in metastatic NSCLC from a societal perspective in the United States. Methods: We constructed a microsimulation model to compare the life expectancy and costs of multiplexed testing and molecularly guided therapy versus treatment with cisplatin-pemetrexed (CisPem). All testing interventions included a two-step algorithm of concurrent EGFR mutation and ALK overexpression testing with immunohistochemistry followed by ALK rearrangement confirmation with a fluorescence in situ hybridization assay for immunohistochemistry-positive results. Three strategies were included: "Test-treat" approach, where molecularly guided therapy was initiated after obtainment of test results; "Empiric switch therapy, " with concurrent initiation of CisPem and testing and immediate switch to test-result conditional treatment after one cycle of CisPem; and "Empiric therapy" approach in which CisPem was continued for four cycles before start of a tyrosine kinase inhibitor. Results: The incremental cost-effectiveness ratio for "Test-treat" compared with treatment with CisPem was $136, 000 per quality-adjusted life year gained. Both empiric treatment approaches had less favorable incremental cost-effectiveness ratios. "Test-treat" and "Empiric switch therapy" yielded higher expected outcomes in terms of quality-adjusted life years and life-years than "Empiric therapy." These results were robust across plausible ranges of model inputs. Conclusion: From a societal perspective, our cost-effectiveness results support the value of multiplexed genetic screening and molecularly guided therapy in metastatic NSCLC.