Cost-effectiveness of a new autoantibody test added to Computed Tomography (CT) compared to CT surveillance alone in the diagnosis of lung cancer amongst patients with indeterminate pulmonary nodules

• Published in: PloS one 2020-09, Vol.15 (9), p.e0237492-e0237492
• Main Authors: Sutton, Andrew John, Sagoo, Gurdeep S, Jackson, Leon, Fisher, Mike, Hamilton-Fairley, Geoffrey, Murray, Andrea, Hill, Adam
• Format: Article
• Language: English
• Subjects: Autoantibodies; Biology and Life Sciences; Biopsy; CAT scans; Computed tomography; Cost analysis; Decision trees; Diagnosis; Health aspects; Health surveillance; Hospitals; Immunoassay; Laboratories; Lung cancer; Lung diseases; Lung nodules; Malignancy; Markov chains; Mathematical models; Medical diagnosis; Medical imaging; Medical research; Medicine and Health Sciences; Methods; Mortality; Nodules; Parameter uncertainty; Patients; Research and Analysis Methods; Social Sciences; Surgery; Thorax; Tomography
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0237492

Oncimmune's EarlyCDT®-Lung is a simple ELISA blood test that measures seven lung cancer specific autoantibodies and is used in the assessment of malignancy risk in patients with indeterminate pulmonary nodules (IPNs). The objective of this study was to examine the cost-effectiveness of EarlyCDT-Lung in the diagnosis of lung cancer amongst patients with IPNs in addition to CT surveillance, compared to CT surveillance alone which is the current recommendation by the British Thoracic Society guidelines. A model consisting of a combination of a decision tree and Markov model was developed using the outcome measure of the quality adjusted life year (QALY). A life-time time horizon was adopted. The model was parameterized using a range of secondary sources. At £70 per test, EarlyCDT-Lung and CT surveillance was found to be cost-effective compared to CT surveillance alone with an incremental cost-effectiveness ratio (ICER) of less than £2,500 depending on the test accuracy parameters used. It was also found that EarlyCDT-Lung can be priced up to £1,177 and still be cost-effective based on cost-effectiveness acceptance threshold of £20,000 / QALY. Further research to resolve parameter uncertainty, was not found to be of value. The results here demonstrate that at £70 per test the EarlyCDT-Lung will have a positive impact on patient outcomes and coupled with CT surveillance is a cost-effective approach to the management of patients with IPNs. The conclusions drawn from this analysis are robust to realistic variation in the parameters used in the model.