Cost-Effectiveness Analysis of Three Diagnostic Strategies for the Detection of EGFR Mutation in Advanced Non-Small Cell Lung Cancer

In non-small cell lung cancer (NSCLC), epidermal growth factor receptor ( ) mutation testing of tumor tissue should be conducted at diagnosis. Alternatively, circulating tumor DNA can be used to detect mutation. We compared the cost and clinical effect of three strategies according to the applicatio...

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Bibliographic Details
Published in:Annals of laboratory medicine 2023, 43(6), , pp.605-613
Main Authors: Cho, Sun Mi, Lee, Hye Sun, Jeon, Soyoung, Kim, Yoonjung, Kong, Sun-Young, Lee, Jin Kyung, Lee, Kyung-A
Format: Article
Language:English
Subjects:
Carcinoma, Non-Small-Cell Lung - diagnosis
Carcinoma, Non-Small-Cell Lung - genetics
Cost-Effectiveness Analysis
ErbB Receptors - genetics
Humans
Lung Neoplasms - diagnosis
Lung Neoplasms - genetics
Mutation
Original
Protein Kinase Inhibitors - therapeutic use
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Summary:In non-small cell lung cancer (NSCLC), epidermal growth factor receptor ( ) mutation testing of tumor tissue should be conducted at diagnosis. Alternatively, circulating tumor DNA can be used to detect mutation. We compared the cost and clinical effect of three strategies according to the application of the test. Decision models were developed to compare the cost-effectiveness of tissue-only, tissue-first, and plasma-first diagnostic strategies as first- and second-line treatments for NSCLC from the perspective of the Korean national healthcare payer. Progression-free survival (PFS), overall survival (OS), and direct medical costs were assessed. A one-way sensitivity analysis was performed. The plasma-first strategy correctly identified numerous patients in the first- and second-line treatments. This strategy also decreased the cost of biopsy procedures and complications. Compared with that when using the other two strategies, the plasma-first strategy increased PFS by 0.5 months. The plasma-first strategy increased OS by 0.9 and 1 month compared with that when using the tissue-only and tissue-first strategies, respectively. The plasma-first strategy was the least expensive first-line treatment but the most expensive second-line treatment. First-generation tyrosine kinase inhibitor and the detection rate of the T790M mutation in tissues were the most cost-influential factors. The plasma-first strategy improved PFS and OS, allowing for a more accurate identification of candidates for targeted therapy for NSCLC and decreased biopsy- and complication-related costs.
ISSN:2234-3806
2234-3814
DOI:10.3343/alm.2023.43.6.605