ADVERTISEMENT
Cost-Effectiveness of Tumor Genomic Profiling to Among Patients With Metastatic Lung Adenocarcinoma
When compared with no tumor profiling in patients with metastatic lung adenocarcinoma, tumor profiling may improve quality-adjusted survival but is not cost-effective, according to a recent cost-effective analysis (Value Health. 2022;25(4):582-594; doi:10.1016/ j.jval.2021.09.017).
The optimal approach to tumor profiling in advanced non–small cell lung cancer (NSCLC) remains uncertain. While comprehensive genomic profiling (CGP) tests for a broad range of genetic alterations in comprehensive sets of oncogenes, targeted gene panel testing (TGPT) tests for common alterations in selected oncogenes.
Aiming to clarify the most cost-effective approach to tumor profiling, Olivia M. Dong, PhD, MPH, Duke Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, and colleagues used cost data from the Centers for Medicare and Medicaid Services to conduct cost-effectiveness analyses that compared CGP of 10 oncogenes, TGPT of 4 oncogenes, and no tumor profiling over the lifetime of patients with metastatic lung adenocarcinoma.
This analysis did not yield estimates lower than the willingness-to-pay threshold of $150,000 per quality-adjusted life-year (QALY) gained. Therefore, Dr Dong and colleagues concluded that tumor genetic profiling for selecting first-line, cancer-directed, targeted therapies did not produce enough gain in QALYs to counterbalance the high cost of these therapies.
In their analysis, researchers used a decision analytic model that included 10,000 hypothetical Medicare beneficiaries with metastatic lung adenocarcinoma. With this model, they simulated outcomes associated with CGP assessing ALK, BRAF, EGFR, ERBB2, MET, MTRK1, NTR2, NTRK3, RET, and ROS1, outcomes associated with TGPT assessing ALK, BRAF, EGFR, and ROS1, and outcomes associated with no tumor profiling and, therefore, no genetic testing.
In their simulation, first-line, targeted, cancer-directed therapies were assumed to be used if actionable gene variants were detected. Otherwise, nontargeted cancer-directed therapies were assumed to be used.
The researchers sourced model inputs for progression-free survival and adverse events from randomized trials. They obtained model inputs for drug costs from the Veterans Health Administration and Medicare and inputs for nondrug costs related to cancer management and for health state utilities from published studies. Moreover, they sourced actionable variant prevalence from published databases. In addition, they discounted costs in 2019 US dollars and QALYs by 3% annually and used Monte Carlo simulations for their probabilistic sensitivity analyses.
As a result, they found that no tumor profiling cost the least per person ($122,613 vs. $184,063 for TGPT and $188,425 for CGP). However, no tumor profiling produced the lowest QALY gain per person at 0.53 QALY, compared with 0.73 QALY for TGPT and 0.74 QALY for CGP.
They also found that the lifetime costs per QALY gained were $445,545 (95% confidence interval [CI], $322,297 to $572,084) for CGP compared with TGPT and were $310,735 (95% CI, $278,323 to $347,952) for TGPT compared with no tumor profiling. “All probabilistic sensitivity analysis simulations for both comparisons surpassed the willingness-to-pay threshold ($150,000 per QALY gained),” wrote Dr Dong and colleagues.
“Compared with no tumor profiling in patients with metastatic lung adenocarcinoma, tumor profiling (TGPT, CGP) improves quality-adjusted survival but is not cost-effective,” the team concluded.
