Economic Evaluation of Companion Diagnostic Testing for EGFR Mutations and First-Line Targeted Therapy in Advanced Non-Small Cell Lung Cancer Patients in South Korea

• Published in: PloS one Vol. 11; no. 8; p. e0160155
• Main Authors: Lim, Eun-A, Lee, Haeyoung, Bae, Eunmi, Lim, Jaeok, Shin, Young Kee, Choi, Sang-Eun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.08.2016; Public Library of Science (PLoS)
• Subjects: Adenocarcinoma; Adenocarcinoma - drug therapy; Adenocarcinoma - economics; Adenocarcinoma - pathology; Adenocarcinoma of Lung; Aged; Analysis; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Asian people; Biological markers; Biomarkers; Cancer; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - pathology; Care and treatment; Chemotherapy; Clinical medicine; Comparative analysis; Computer simulation; Cost analysis; Cost-Benefit Analysis; Decision Trees; Diagnosis; Diagnostic systems; Diagnostic tests; Economic aspects; Epidermal growth factor; Epidermal growth factor receptors; Epidermal growth factors; ErbB Receptors - genetics; Erlotinib Hydrochloride - economics; Erlotinib Hydrochloride - therapeutic use; Female; Gene Expression; Genetic aspects; Health care; Health Care Costs; Health care policy; Histology; Humans; Laboratories; Lung cancer; Lung diseases; Lung Neoplasms - drug therapy; Lung Neoplasms - economics; Lung Neoplasms - pathology; Male; Markov Chains; Markov processes; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Molecular Targeted Therapy; Mutation; Neoplasm Staging; Non-small cell lung cancer; Non-small cell lung carcinoma; Patients; Pharmacy; Physiological aspects; Population studies; Precision Medicine; Protein Kinase Inhibitors - economics; Protein Kinase Inhibitors - therapeutic use; Quality-Adjusted Life Years; Republic of Korea; Risk factors; Sensitivity analysis; Social Sciences; Strategy; Studies; Therapy; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0160155

As targeted therapy becomes increasingly important, diagnostic techniques for identifying targeted biomarkers have also become an emerging issue. The study aims to evaluate the cost-effectiveness of treating patients as guided by epidermal growth factor receptor (EGFR) mutation status compared with a no-testing strategy that is the current clinical practice in South Korea. A cost-utility analysis was conducted to compare an EGFR mutation testing strategy with a no-testing strategy from the Korean healthcare payer's perspective. The study population consisted of patients with stage 3b and 4 lung adenocarcinoma. A decision tree model was employed to select the appropriate treatment regimen according to the results of EGFR mutation testing and a Markov model was constructed to simulate disease progression of advanced non-small cell lung cancer. The length of a Markov cycle was one month, and the time horizon was five years (60 cycles). In the base case analysis, the testing strategy was a dominant option. Quality-adjusted life-years gained (QALYs) were 0.556 and 0.635, and total costs were $23,952 USD and $23,334 USD in the no-testing and testing strategy respectively. The sensitivity analyses showed overall robust results. The incremental cost-effectiveness ratios (ICERs) increased when the number of patients to be treated with erlotinib increased, due to the high cost of erlotinib. Treating advanced adenocarcinoma based on EGFR mutation status has beneficial effects and saves the cost compared to no testing strategy in South Korea. However, the cost-effectiveness of EGFR mutation testing was heavily affected by the cost-effectiveness of the targeted therapy.