晚期EGFR/ALK阴性非小细胞肺癌的下一代测序的成本效益
Cost-effectiveness of next-generation sequencing for advanced EGFR/ALK-negative non-small cell lung cancer
影响因子:4.40000
分区:医学2区 / 肿瘤学3区 呼吸系统3区
发表日期:2024 Nov
作者:
Dong-Won Kang, Sun-Kyeong Park, Sokbom Kang, Eui-Kyung Lee
摘要
这项研究旨在评估下一代测序（NGS）与顺序单基因测试（SGT）的成本效益，包括先进的EGFR/ALK阴性非小型非小型细胞肺癌（NSCLC）的长期成本和相关处理的长期成本和生存结果。我们开发了一个决策树，开发了一个跨越型号的分析范围的临时模型，并在五年级的生存过程中进行了临床范围的估计，以估算为估计，以估算为准。决策树由基于分子生物标志物（ROS1，BRAF，NTRK，MET，MET，RET和KRAS改变）的治疗类型组成。根据1）测试率估算接受每种靶向治疗的可能性，2）检测到的改变比例； 3）接受与测试结果一致的接受治疗的患者比例。我们通过重建临床试验中的患者水平数据来估算每种治疗的长期总体生存和无进展生存期。包括测试，药物，管理，医师探视，监测，不良事件，后期和临终关心的成本。实用程序值是从先前的研究中获得的。使用增量的成本效益比（ICER）来评估NGS在每位质量调整质量调整的终身年份（QALY）的阈值38,701美元（50,000,000 krw）之内的成本效益（QALY）。 NGS集团的总医疗费用比中士集团高出8,375美元。药物成本差异造成了总医疗费用的大多数差异。与连续SGT相比，NGS没有成本效益，ICER为300,233美元/ly和$ 359,405/QALY。ngs对高级EGFR/ALK-alk-nsclc的成本有效，但与顺序SGT相比具有生存益处。我们的发现为在EGFR改变的地区的覆盖范围和临床利用方面提供了决策基础。
Abstract
This study aimed to evaluate the cost-effectiveness of next-generation sequencing (NGS) versus sequential single-gene testing (SGT), including the long-term costs and survival outcomes of relevant treatments for advanced EGFR/ALK-negative non-small cell lung cancer (NSCLC).We developed a decision tree linked to a partitioned survival model to estimate the clinical outcomes and costs over the five-year analysis period. The decision tree consisted of treatment types based on molecular biomarker (ROS1, BRAF, NTRK, MET, RET, and KRAS alterations) test results. The probability of receiving each targeted therapy was estimated based on 1) the testing rate, 2) the proportion of alterations detected, and 3) the proportion of patients receiving treatment consistent with the testing results. We estimated the long-term overall survival and progression-free survival for each treatment using parametric estimation by reconstructing patient-level data from clinical trials. The costs of testing, drugs, administration, physician visits, monitoring, adverse events, post-progression, and end-of-life care were included. The utility values were obtained from a previous study. The incremental cost-effectiveness ratio (ICER) was used to evaluate the cost-effectiveness of NGS within a threshold of $38,701 (50,000,000 KRW) per quality-adjusted life year (QALY).The incremental life-years (LYs) and QALYs for the NGS group versus the SGT group were 0.028 and 0.023, respectively. The total medical cost for the NGS group was $8,375 higher than that for the SGT group. The difference in drug costs accounted for most of the differences in total medical costs. NGS was not cost-effective compared to sequential SGT, with an ICER of $300,233/LY and $359,405/QALY, respectively.NGS is not cost-effective for advanced EGFR/ALK-negative NSCLC, but has a survival benefit over sequential SGT. Our findings provide a basis for decision-making regarding the coverage and clinical utilization of NGS in regions where EGFR alterations are prevalent.