Cost-effectiveness of KRAS, EGFR and ALK testing for decision making in advanced nonsmall cell lung carcinoma: the French IFCT-PREDICT.amm study. - PubMed - NCBI
Eur Respir J. 2018 Mar 15;51(3). pii: 1701467. doi: 10.1183/13993003.01467-2017. Print 2018 Mar.
Cost-effectiveness of KRAS, EGFR and ALK testing for decision making in advanced nonsmall cell lung carcinoma: the French IFCT-PREDICT.amm study.
Loubière S1,2,
Drezet A3,
Beau-Faller M4,
Moro-Sibilot D5,
Friard S6,
Wislez M7,
Blons H8,
Daniel C9,
Westeel V10,
Madroszyk A11,
Léna H12,
Merle P13,
Mazières J14,
Zalcman G15,16,
Lacave R17,
Antoine M18,
Morin F19,
Missy P19,
Barlesi F20,
Auquier P3,2,
Cadranel J7;
French Cooperative Thoracic Intergroup (IFCT).
Abstract
ALK rearrangement and EGFR/KRAS mutations constitute the primary biomarkers tested to provide targeted or nontargeted therapies in advanced nonsmall cell lung cancer (NSCLC) patients. Our objective was to assess the cost-effectiveness of biomarker testing for NSCLC.Between 2013 and 2014, 843 treatment-naive patients were prospectively recruited at 19 French hospitals into a longitudinal observational cohort study. Two testing strategies were compared, i.e. with "at least one biomarker status known" and "at least KRAS status known", in addition to "no biomarker testing" as the reference strategy. The Kaplan-Meier approach was employed to assess restricted mean survival time. Direct medical costs incurred by hospitals were estimated with regard to treatment, inpatient care and biomarker testing.Compared with "no biomarker testing", the "at least one biomarker status known" strategy yielded an incremental cost-effectiveness ratio of EUR13 230 per life-year saved, which decreased to EUR7444 per life-year saved with the "at least KRAS status known" testing strategy. In sensitivity analyses, biomarker testing strategies were less costly and more effective in 41% of iterations.In summary, molecular testing prior to treatment initiation proves to be cost-effective in advanced NSCLC management and may assist decision makers in defining conditions for further implementation of these innovations in general practice.
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