Modelling of Lung Cancer Therapy; Modelled And Real-World Impact of Targeted Therapy And Immunotherapy In The Netherlands

Abstract

Recent discoveries in molecular diagnostics and lung cancer drugs have improved the treatment of patients with advanced (inoperable) non-squamous NSCLC from solely platinum based chemotherapy to more personalized treatment including targeted therapies and immunotherapies. However, these improvements come at considerable costs, highlighting the need to assess cost-effectiveness for optimization of lung cancer care. Traditionally, cost-effectiveness models built to evaluate new lung cancer treatments were based on randomized control trial (RCT) findings. The strict RCT inclusion criteria make RCT patients not representative of real-world patients: Patients in RCT have better prognosis compared to real-world patients. Therefore, in this study we have developed and validated a diagnosis-treatment decision model for patients with advanced (inoperable) non-squamous NSCLC based on real-world data in the Netherlands. The model is a patient-level microsimulation model implemented as discrete event simulation with five health events. Patients are simulated from diagnosis to death, including at most three treatment lines. The base-model (non-personalized strategy) was populated using real-world data of patients treated with platinum-based chemotherapy between 2008 – 2014 in one of six Dutch’s teaching hospitals. To allow simulation of personalized care, molecular tumor characteristics were incorporated in the model based on the literature. The impact of novel targeted treatments and immunotherapies was included based on published RCTs. To validate the model, we compared survival under a personalized treatment strategy against observed real-world survival. This model can be used for health-care evaluation of personalized treatment for patients with advanced (inoperable) NSCLC in the Netherlands.

Cost-Effectiveness of Parallel Versus Sequential Testing of Genetic Aberrations for Stage IV Non–Small-Cell Lung Cancer in the Netherlands

“…To study the cost-effectiveness of diagnostic testing strategies in stage IV nonsquamous NSCLC, a diagnostic model was developed and coupled to the output of a Dutch treatment model 9 that predicts life-years lived (LY), QALYs, and costs for each currently used NSCLC drug treatment in the appropriate patient subgroups. The frequencies of detected genetic aberrations in the simulated cohort were determined in the diagnostic model.…”

“…The NSCLC treatment model was developed by Mfumbilwa et al 9 (Data Supplement), which allowed investigating the cost-effectiveness of different test and treatment combinations in patients with NSCLC in a real-world setting. The allocated therapy for each molecular subgroup was based on current clinical practice, as described in the Dutch guidelines 2 and discussed with clinical experts.…”

“…We first investigated the average diagnostic costs and the percentage of patients with a correct test result received within 2 weeks after initiation of a test strategy. Second, the diagnostic model was linked to a Dutch treatment model, 9 to provide output on total medical costs and quality-adjusted life-years (QALYs) lived when patients in the cohort are treated according to the recommended treatments for each diagnostic strategy.…”