下一代测序在晚期EGFR/ALK阴性非小细胞肺癌中的成本效益分析
Cost-effectiveness of next-generation sequencing for advanced EGFR/ALK-negative non-small cell lung cancer
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影响因子:4.4
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
DOI:
10.1016/j.lungcan.2024.107970
摘要
本研究旨在评估下一代测序（NGS）与序贯单基因检测（SGT）在晚期EGFR/ALK阴性非小细胞肺癌（NSCLC）相关治疗的长期成本和生存结局中的成本效益。我们开发了一个与分割生存模型相关联的决策树，用于估算五年分析期内的临床结果和成本。决策树包括基于分子生物标志物（ROS1、BRAF、NTRK、MET、RET和KRAS变异）检测结果的治疗类型。接受每种靶向治疗的概率基于1）检测率，2）检测到的变异比例，以及3）与检测结果一致的治疗比例。我们利用从临床试验中重建的患者层级数据，通过参数估算方法，评估了每种治疗的长期总生存期（OS）和无进展生存期（PFS）。包括检测、药物、给药、医生访问、监测、不良事件、进展后治疗和临终护理的成本均被纳入。效用值来源于前期研究。采用增量成本效益比（ICER）在每个质量调整生命年（QALY）$38,701（50,000,000韩元）阈值内评估NGS的成本效益。与SGT组相比，NGS组的增量寿命年（LYs）和QALYs分别为0.028和0.023。NGS的总医疗成本比SGT组高出$8,375。药物成本的差异占总医疗成本差异的主要部分。与序贯SGT相比，NGS的成本-效益比为每生命年$300,233和每QALY$359,405，表明其成本效益不足。结论表明，NGS对于晚期EGFR/ALK阴性NSCLC并不具有成本效益，但在生存方面优于序贯SGT。我们的研究为在EGFR变异普遍地区关于NGS覆盖范围和临床利用的决策提供了依据。
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.