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Genetic Screening Deemed Cost-Effective in
Non–Small Cell Lung Cancer

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Key Points

  • EFGR mutations and ALK gene rearrangements have a relatively low presence in unselected NSCLC tumors. However, when genetic abnormalities are present, guided or targeted drug therapies are effective.
  • The incremental cost-effectiveness ratio for testing for these abnormalities and then determining treatment, compared to treatment with chemotherapy with no testing, was $136,000 per quality-adjusted life year gained.
  • The findings support the value of multiplexed genetic screening and molecularly guided therapy in NSCLC.

Multiplexed genetic screening for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) gene rearrangements, and subsequent biomarker-guided treatment, is cost-effective compared with standard chemotherapy treatment without any molecular testing in the metastatic non–small cell lung cancer (NSCLC) setting in the United States. These findings are reported by Romanus et al in the Journal of Thoracic Oncology.

In NSCLC, there are specific genetic abnormalities within the tumor that can be exploited with drugs specific for the molecular abnormality. These molecularly-guided or targeted therapies have been shown to be effective for tumors with EGFR mutations and ALK rearrangements.

However, the presence of EGFR mutations and ALK rearrangements is low in unselected NSCLC, 9.5% and 3.9%, respectively. Likewise, the cost associated with molecular testing, along with the question of whether to wait for molecular results or start chemotherapy immediately, has led to complexity in treatment decision-making.

Study Details

Researchers at Harvard’s School of Public Health constructed a microsimulation model to compare life expectancy and costs of multiplexed EGFR and ALK testing. They simulated multiplexed EGFR and ALK testing followed by molecularly-guided therapy compared with three separate scenarios: chemotherapy with no testing; chemotherapy until the testing results were returned, followed by a switch to targeted therapy; or a complete course of chemotherapy followed by targeted therapy if indicated.

Results show that the incremental cost-effectiveness ratio for testing and waiting for results, compared to treatment with chemotherapy with no testing, was $136,000 per quality-adjusted life year gained. Both treatment approaches where chemotherapy was started, and then either switched immediately to targeted therapy, or switched after a complete course of chemotherapy, had less favorable incremental cost-effectiveness ratios. The test-and-treat and chemotherapy with immediate switch approaches yielded higher expected outcomes in terms of quality-adjusted life years and life-years than the complete chemotherapy before targeted therapy approach.

“This analysis supports the value of multiplexed testing for EGFR and ALK gene rearrangements followed by molecularly guided therapy in decisions surrounding coverage of related testing and targeted therapy,” stated lead author Dorothy Romanus, PhD. Ensuring patient access to said breakthrough therapies through lower cost sharing is key. As evidence evolves and testing for a wider range of known mutations in NSCLC enters routine care, it will be increasingly important for future economic analyses to consider multiplexed testing for multiple mutations in tandem, to fully appreciate the value of personalized treatment in this disease."

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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