Economic Evaluation of Companion Diagnostic Testing for EGFR Mutations and First-Line Targeted Therapy in Advanced Non-Small Cell Lung Cancer Patients in South Korea

Abstract

BackgroundAs targeted therapy becomes increasingly important, diagnostic techniques for identifying targeted biomarkers have also become an emerging issue. The study aims to evaluate the cost-effectiveness of treating patients as guided by epidermal growth factor receptor (EGFR) mutation status compared with a no-testing strategy that is the current clinical practice in South Korea.MethodsA cost-utility analysis was conducted to compare an EGFR mutation testing strategy with a no-testing strategy from the Korean healthcare payer’s perspective. The study population consisted of patients with stage 3b and 4 lung adenocarcinoma. A decision tree model was employed to select the appropriate treatment regimen according to the results of EGFR mutation testing and a Markov model was constructed to simulate disease progression of advanced non-small cell lung cancer. The length of a Markov cycle was one month, and the time horizon was five years (60 cycles).ResultsIn the base case analysis, the testing strategy was a dominant option. Quality-adjusted life-years gained (QALYs) were 0.556 and 0.635, and total costs were $23,952 USD and $23,334 USD in the no-testing and testing strategy respectively. The sensitivity analyses showed overall robust results. The incremental cost-effectiveness ratios (ICERs) increased when the number of patients to be treated with erlotinib increased, due to the high cost of erlotinib.ConclusionTreating advanced adenocarcinoma based on EGFR mutation status has beneficial effects and saves the cost compared to no testing strategy in South Korea. However, the cost-effectiveness of EGFR mutation testing was heavily affected by the cost-effectiveness of the targeted therapy.

Value of Precision Medicine in Advanced Non-Small Cell Lung Cancer: Real-World Outcomes Associated with the Use of Companion Diagnostics

“…These findings are consistent with previous research demonstrating that testing may be driven by patient phenotypes [24]. For example, in NSCLC, EGFR mutations are more common in female patients and never‐smokers, and approximately 20%–40% of Asian patients with NSCLC have EGFR mutations [25], which may drive increased use of CDx testing in these patients. Given the benefit of CDx testing observed in this study, there may be additional opportunities to improve testing rates in specific subpopulations who may be less likely to be tested.…”

Comparative effectiveness and cost-effectiveness of three first-line EGFR-tyrosine kinase inhibitors: Analysis of real-world data in a tertiary hospital in Taiwan

“…Most studies analyzed the cost-effectiveness of EGFR testing [25][26][27][28][29] or EGFR-TKI versus chemotherapy as first-line treatment [30][31][32][33][34]. Direct comparisons between different first-line EGFR-TKIs, however, have been performed less frequently.…”

Cost-effectiveness of precision medicine: a scoping review

“…The cost of treatment, if the treatment is a “companion” treatment, also influences the cost-effectiveness of PM (Buchanan et al 2017; Horster et al 2017; Jahn et al 2015; Lim et al 2016; Ruiz-Iruela et al 2016). A companion treatment is marketed together with a specific genetic test.…”