Dorothy Romanus1, Stephanie Cardarella, David Cutler, Mary Beth Landrum, Neal I Lindeman, G Scott Gazelle. 1. *Institute for Technology Assessment, Massachusetts General Hospital, Harvard University, Boston, Massachusetts; †Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; ‡Department of Economics, Harvard University, Cambridge, Massachusetts; §Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; ‖Department of Pathology, Brigham and Women' Hospital, Harvard Medical School, Boston, Massachusetts; and ¶Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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.
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.
Authors: Rafael Rosell; Enric Carcereny; Radj Gervais; Alain Vergnenegre; Bartomeu Massuti; Enriqueta Felip; Ramon Palmero; Ramon Garcia-Gomez; Cinta Pallares; Jose Miguel Sanchez; Rut Porta; Manuel Cobo; Pilar Garrido; Flavia Longo; Teresa Moran; Amelia Insa; Filippo De Marinis; Romain Corre; Isabel Bover; Alfonso Illiano; Eric Dansin; Javier de Castro; Michele Milella; Noemi Reguart; Giuseppe Altavilla; Ulpiano Jimenez; Mariano Provencio; Miguel Angel Moreno; Josefa Terrasa; Jose Muñoz-Langa; Javier Valdivia; Dolores Isla; Manuel Domine; Olivier Molinier; Julien Mazieres; Nathalie Baize; Rosario Garcia-Campelo; Gilles Robinet; Delvys Rodriguez-Abreu; Guillermo Lopez-Vivanco; Vittorio Gebbia; Lioba Ferrera-Delgado; Pierre Bombaron; Reyes Bernabe; Alessandra Bearz; Angel Artal; Enrico Cortesi; Christian Rolfo; Maria Sanchez-Ronco; Ana Drozdowskyj; Cristina Queralt; Itziar de Aguirre; Jose Luis Ramirez; Jose Javier Sanchez; Miguel Angel Molina; Miquel Taron; Luis Paz-Ares Journal: Lancet Oncol Date: 2012-01-26 Impact factor: 41.316
Authors: I Borget; J Cadranel; J-P Pignon; E Quoix; B Coudert; V Westeel; E Dansin; J Madelaine; A Madroszyk; S Friard; C Daniel; F Morin; C Chouaid Journal: Eur Respir J Date: 2011-06-09 Impact factor: 16.671
Authors: Giorgio Vittorio Scagliotti; Purvish Parikh; Joachim von Pawel; Bonne Biesma; Johan Vansteenkiste; Christian Manegold; Piotr Serwatowski; Ulrich Gatzemeier; Raghunadharao Digumarti; Mauro Zukin; Jin S Lee; Anders Mellemgaard; Keunchil Park; Shehkar Patil; Janusz Rolski; Tuncay Goksel; Filippo de Marinis; Lorinda Simms; Katherine P Sugarman; David Gandara Journal: J Clin Oncol Date: 2008-05-27 Impact factor: 44.544
Authors: Marie Westwood; Manuela Joore; Penny Whiting; Thea van Asselt; Bram Ramaekers; Nigel Armstrong; Kate Misso; Johan Severens; Jos Kleijnen Journal: Health Technol Assess Date: 2014-05 Impact factor: 4.014
Authors: Julie A Lynch; Muin J Khoury; Ann Borzecki; Jerry Cromwell; Laura L Hayman; Pat Reid Ponte; Glenn A Miller; Christopher S Lathan Journal: Genet Med Date: 2013-02-28 Impact factor: 8.822
Authors: Adrian G Sacher; Suzanne E Dahlberg; Jennifer Heng; Stacy Mach; Pasi A Jänne; Geoffrey R Oxnard Journal: JAMA Oncol Date: 2016-03 Impact factor: 31.777
Authors: Olivia M Dong; Pradeep J Poonnen; David Winski; Shelby D Reed; Vishal Vashistha; Jill Bates; Michael J Kelley; Deepak Voora Journal: Value Health Date: 2021-11-01 Impact factor: 5.725
Authors: Oscar Arrieta; Pablo Anaya; Vicente Morales-Oyarvide; Laura Alejandra Ramírez-Tirado; Ana C Polanco Journal: Eur J Health Econ Date: 2015-09-04
Authors: Peter J Mazzone; Catherine Rufatto Sears; Doug A Arenberg; Mina Gaga; Michael K Gould; Pierre P Massion; Vish S Nair; Charles A Powell; Gerard A Silvestri; Anil Vachani; Renda Soylemez Wiener Journal: Am J Respir Crit Care Med Date: 2017-10-01 Impact factor: 21.405