The cost-effectiveness of screening lung cancer patients for targeted drug sensitivity markers

• Published in: British journal of cancer Vol. 106; no. 6; pp. 1100 - 1106
• Main Authors: Atherly, A J, Camidge, D R
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 13.03.2012; Nature Publishing Group
• Subjects: 692/53/2423; 692/699/67/1612; 692/699/67/2322; 692/700/159; Antineoplastic Agents - pharmacology; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Biomarkers, Tumor - antagonists & inhibitors; Biomarkers, Tumor - metabolism; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - enzymology; Clinical Study; Cost-Benefit Analysis; Drug Resistance; Drug Resistance, Neoplasm; Drugs; Economic models; Epidemiology; Humans; Literature reviews; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - economics; Lung Neoplasms - enzymology; Medical sciences; Models, Biological; Molecular Medicine; Molecular Targeted Therapy - economics; Oncology; Pneumology; Precision Medicine - economics; Pyrazoles - pharmacology; Pyrazoles - therapeutic use; Pyridines - pharmacology; Pyridines - therapeutic use; Quality of Life; Receptor Protein-Tyrosine Kinases - antagonists & inhibitors; Receptor Protein-Tyrosine Kinases - metabolism; Tumors; Tumors of the respiratory system and mediastinum; ALK; lung cancer; cost-effectiveness; crizotinib; EGFR; Human; Lung disease; Respiratory disease; Lung cancer; Biological marker; Malignant tumor; Medical screening; Epidermal growth factor receptor; Cancerology; Health economy; C-Onc gene; Targeted drug; Chemosensitivity; Bronchus disease; Anaplastic lymphoma kinase; Protooncogene; Cancer; Cost efficiency analysis
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2012.60

Background: New oncology drugs are being developed in conjunction with companion diagnostics with approval restricting their use to certain biomarker-positive subgroups. We examined the impact of different predictive biomarker screening techniques and population enrichment criteria on the cost-effectiveness of targeted drugs in lung cancer, using ALK and crizotinib to build the initial model. Methods: Health economic modeling of cost per Quality Adjusted Life Year was based on literature review and expert opinion. The modeled population represented advanced non-small cell lung cancer (NSCLC), eligible for predictive biomarker screening with prescribing restricted to biomarker-positive patients. Results: For assays costing $1400 per person, cost per quality-adjusted life year (QALY) gained for ALK screening all advanced NSCLC, excluding treatment cost, is $106 707. This falls to $4756 when only a highly enriched population is screened (increasing biomarker frequency from 1.6 to 35.9%). However, the same enrichment involves missing 56% patients who segregate within the unscreened group. Cheaper screening tests that miss some true positives can be more cost-effective if proportional reductions in cost exceed proportion of subjects missed. Generic modeling of idealised screening assays, including treatment cost, reveals a dominant effect of screening cost per person at low biomarker frequencies. Cost-effectiveness of <$100 000 per QALY gained is not achievable at biomarker frequencies <5% (with drug costs $1–5000 per month and screening costs $600–1400 per person). Interpretation: Cost-effectiveness of oncology drugs whose prescribing is restricted to biomarker-positive subgroups should address the cost of detecting marker-positive patients. The cost of screening dominates at low frequencies and strategies to improve cost-effectiveness based on the assay cost, drug cost and the group screened should be considered in these scenarios.