Some patients with non-small cell lung cancer (NSCLC) and the clinicians who treat them may be inclined to start a chemotherapy regimen immediately upon diagnosis. However, guidelines recommend patients undergo population-wide genetic screening for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) arrangements to choose a more targeted course of treatment, also known as molecularly-guided therapy. Health gains aside, it is important from a societal perspective to analyze the cost-effectiveness of this type of multiplexed predictive biomarker screening, notes a study published recently in Journal of Thoracic Oncology. The study, led by Dorothy Romanus, PhD, and G. Scott Gazelle, MD, PhD, indicates that testing before treatment is the most cost-effective option.
“This analysis supports the value of multiplexed testing for EGFR and ALK gene rearrangements followed by molecularly-guided therapy in decisions surrounding coverage of related testing and targeted therapy,” said Dr. Romanus in a news release from the International Association for the Study of Lung Cancer.
The study, “Cost-Effectiveness of Multiplexed Predictive Biomarker Screening in Non-Small Cell Lung Cancer,” was conducted using a microsimulation model that compared life expectancy and costs of three treatment strategies. First was the ‘test-treat’ approach, where patients were tested for EGFR mutations and ALK rearrangements before beginning a molecularly-guided therapy. Second was the ’empiric switch therapy’ approach, where patients were started on cisplatin-permetrexed (CisPerm) while waiting for test results and then switched to a different treatment if required. Third was the ’empiric therapy’ approach, where patients underwent four cycles of CisPerm followed by a tyrosine kinase inhibitor (TKI, a targeted therapy) without undergoing any testing.
The ‘test-treat’ approach equated to a $136,000 per quality-adjusted life year savings over ’empiric therapy,’ a figure regarded as good value from a societal perspective. Both empiric approaches exhibited poor incremental cost-effectiveness ratios, but ’empiric switch therapy’ showed a quality-adjusted life year than ’empiric therapy.’
Dr. Romanus highlighted how the team’s study could influence treatment strategies. “Ensuring patient access to said breakthrough therapies through lower cost sharing is key. As evidence evolves and testing for a wider range of known mutations in NSCLC enters routine care, it will be increasingly important for future economic analyses to consider multiplexed testing for multiple mutations in tandem to fully appreciate the value of personalized treatment in this disease,” she said.
Targeted treatments are becoming increasingly important to lung cancer treatment strategies as the technology becomes more available and costs of genetic testing become lower. Studies such as these exemplify how not only is the cost of molecularly-guided therapy superior, but also how quality of treatment is superior in relation to the costs.