Ann Lab Med.  2023 Nov;43(6):605-613. 10.3343/alm.2023.43.6.605.

Cost-Effectiveness Analysis of Three Diagnostic Strategies for the Detection of EGFR Mutation in Advanced Non-Small Cell Lung Cancer

• Cho SM
• Lee HS
• Jeon S
• Kim Y
• Kong SY
• Lee JK
• Lee KA

• KMID: 2552038
• DOI: http://doi.org/10.3343/alm.2023.43.6.605

Abstract

Background
In non-small cell lung cancer (NSCLC), epidermal growth factor receptor (EGFR) mutation testing of tumor tissue should be conducted at diagnosis. Alternatively, circulating tumor DNA can be used to detect EGFR mutation. We compared the cost and clinical effect of three strategies according to the application of the EGFR test.
Methods
Decision models were developed to compare the cost-effectiveness of tissue-only, tissue-first, and plasma-first diagnostic strategies as first- and second-line treatments for NSCLC from the perspective of the Korean national healthcare payer. Progression-free survival (PFS), overall survival (OS), and direct medical costs were assessed. A one-way sensitivity analysis was performed.
Results
The plasma-first strategy correctly identified numerous patients in the first- and second-line treatments. This strategy also decreased the cost of biopsy procedures and complications. Compared with that when using the other two strategies, the plasma-first strategy increased PFS by 0.5 months. The plasma-first strategy increased OS by 0.9 and 1 month compared with that when using the tissue-only and tissue-first strategies, respectively. The plasma-first strategy was the least expensive first-line treatment but the most expensive second-line treatment. First-generation tyrosine kinase inhibitor and the detection rate of the T790M mutation in tissues were the most cost-influential factors.
Conclusions
The plasma-first strategy improved PFS and OS, allowing for a more accurate identification of candidates for targeted therapy for NSCLC and decreased biopsy- and complication-related costs.

Keyword

Cost-effectiveness; EGFR; Mutation; Non-small-cell lung cancer

Figure

• 

  Fig. 1 Schematic representation of the diagnostic strategies analyzed in this study. (A) First-line treatment (B) Second-line treatment. Abbreviations: EGFR, epidermal growth factor receptor; TKI, tyrosine kinase inhibitor; 3rd-gen, third-generation.

• 

  Fig. 2 Tornado diagram of sensitivity analysis. (A) Tissue-only strategy. (B) Tissue-first strategy. (C) Plasma-first strategy in first-line treatment. (D) Tissue-only strategy. (E) Tissue-first strategy. (F) Plasma-first strategy in second-line treatment. The horizontal bars in the tornado diagrams indicate how wide the variation in the total cost due to a change in a given input is. At the time of first diagnosis, first-generation TKI is the most cost-influential factor. At the time of disease progression, T790M status in tumor tissue is the most cost-influential factor. Abbreviations: 1st-gen, first-generation; TKI, tyrosine kinase inhibitor.

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