Cost-Effectiveness of Multiplexed Predictive Biomarker Screening in Non-Small-Cell Lung Cancer

摘要: Introduction Population-wide screening for epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) gene rearrangements to inform cancer therapy in non-small-cell lung (NSCLC) is recommended by guidelines. We estimated cost-effectiveness of multiplexed predictive biomarker metastatic NSCLC from a societal perspective the United States. Methods constructed microsimulation model compare life expectancy costs testing molecularly guided versus treatment with cisplatin-pemetrexed (CisPem). All interventions included two-step algorithm concurrent EGFR mutation ALK overexpression immunohistochemistry followed rearrangement confirmation fluorescence situ hybridization assay immunohistochemistry-positive results. Three strategies were included: "Test-treat" approach, where was initiated after obtainment test results; "Empiric switch therapy," initiation CisPem immediate test-result conditional one cycle CisPem; therapy" approach which continued four cycles before start tyrosine inhibitor. Results The incremental ratio compared $136,000 per quality-adjusted year gained. Both empiric approaches had less favorable ratios. yielded higher expected outcomes terms years life-years than therapy." These results robust across plausible ranges inputs. Conclusion From perspective, our support value genetic NSCLC.