Review Determines Cost-effectiveness of Precision Diagnostic Testing in NSCLC

Seeking to determine the cost-effectiveness of precision diagnostic testing (PDT) for precision medicine in non-small cell lung cancer (NSCLC), researchers recently conducted a systematic review of the available literature.

The analysis included 64 cost-effectiveness analysis scenarios across more than 30 studies between 2009 and 2019, approximately half (53%) of which determined PDT to be cost effective. When the researchers compared PDT-guided therapy with a treat-all-patients approach, all tested scenarios suggested that PDT was cost effective.

Among the scenarios were those that compared therapy guided by PDT with non-guided therapy (epidermal growth factor receptor [EGFR]- and programmed death-ligand 1 [PD-L1]-guided treatment), those that compared PDT-guided therapy with chemotherapy alone (anaplastic lymphoma kinase-, EGFR-, and PD-L1-guided treatment), and those that compared PDT-guided treatment with chemotherapy alone while varying the PDT approach.

The researchers observed that the life year gained or quality-adjusted life-year gained with EGFR-directed therapy were more pronounced in Asian studies compared with North American or European studies, likely because the presence of EGFR mutations is higher in Asia.

“Our analyses strongly suggest that health economic evaluation should be performed routinely from the start of and alongside clinical trials,” commented the researchers. “This is particularly true for precision oncology, where therapeutic costs are high and improved patient outcomes achieved through application of a relatively inexpensive PDT would be beneficial, both from a clinical and a health economic viewpoint.”

Through their analysis, the researchers also found that the majority (81%) of the studies were poorly designed. They explain that just 7 of the studies were designed appropriately to determine the cost effectiveness of PDT-guided treatment.

Among the 62 scenarios, just 11 used the appropriate analysis format—comparing precision medicine and PDT with precision administered without patient selection based on testing—to determine whether PDT adds value to precision medicine. Seven of these 11 scenarios confirmed the researchers’ hypothesis that PDT-guided treatment added a “measurable increased benefit.” The other 4 had conflicting results, which the researchers say may be a result of the studies being mislabeled as dominated rather than dominant studies.

“Our systematic analysis implies that more robust health economic evaluation could help identify additional approaches towards PDT cost-effectiveness, underpinning value-based care and enhanced outcomes for patients with NSCLC,” wrote the researchers.

Reference

Henderson R, Keeling P, French D, Smart D, Sullivan R, Lawler M. Cost-effectiveness of precision diagnostic testing for precision medicine approaches against non-small-cell lung cancer: A systematic review. Mol Oncol. Published online June 10, 2021. doi:10.1002/1878-0261.13038