Journal Article

Cost‐effectiveness of precision diagnostic testing for precision medicine approaches against non‐small‐cell lung cancer: A systematic review

Lawler, Mark, French, Declan, Sullivan, Richard, Smart, Dave, Henderson, Raymond, Keeling, Peter

2021

Overview

Precision diagnostic testing (PDT) employs appropriate biomarkers to identify cancer patients that may optimally respond to precision medicine (PM) approaches, such as treatments with targeted agents and immuno‐oncology drugs. To date, there are no published systematic appraisals evaluating the cost‐effectiveness of PDT in non‐small‐cell lung cancer (NSCLC). To address this gap, we conducted Preferred Reporting Items for Systematic Reviews and Meta‐Analyses searches for the years 2009–2019. Consolidated Health Economic Evaluation Reporting Standards were employed to screen, assess and extract data. Employing base costs, life years gained or quality‐adjusted life years, as well as willingness‐to‐pay (WTP) threshold for each country, net monetary benefit was calculated to determine cost‐effectiveness of each intervention. Thirty‐seven studies (50%) were included for analysis; a further 37 (50%) were excluded, having failed population‐, intervention‐, comparator‐, outcomes‐ and study‐design criteria. Within the 37 studies included, we defined 64 scenarios. Eleven scenarios compared PDT‐guided PM with non‐guided therapy [epidermal growth factor receptor (EGFR), n = 5; programmed death‐ligand 1 (PD‐L1), n = 6]. Twenty‐eight scenarios compared PDT‐guided PM with chemotherapy alone (anaplastic lymphoma kinase, n = 3; EGFR, n = 17; PD‐L1, n = 8). Twenty‐five scenarios compared PDT‐guided PM with chemotherapy alone, while varying the PDT approach. Thirty‐four scenarios (53%) were cost‐effective, 28 (44%) were not cost‐effective, and two were marginal, dependent on their country’s WTP threshold. When PDT‐guided therapy was compared with a therapy‐for‐all patients approach, all scenarios (100%) proved cost‐effective. Seven of 37 studies had been structured appropriately to assess PDT‐PM cost‐effectiveness. Within these seven studies, all evaluated scenarios were cost‐effective. However, 81% of studies had been poorly designed. Our systematic analysis implies that more robust health economic evaluation could help identify additional approaches towards PDT cost‐effectiveness, underpinning value‐based care and enhanced outcomes for patients with NSCLC. Precision diagnostic testing guides therapy to non‐small‐cell lung carcinoma (NSCLC) patients who will best respond, increasing both quantity and quality of life. Our analysis demonstrates the inherent value of precision medicines for NSCLC patients in over half of cases. However, to build the health economic evidence base further, cost‐effectiveness analyses should be appropriately designed to maximise the potential of precision diagnostic testing.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Apoptosis / biomarker / Cancer immunotherapy / Cancer therapies / Carcinoma, Non-Small-Cell Lung - diagnosis / Carcinoma, Non-Small-Cell Lung - drug therapy / Chemotherapy / Cost analysis / Cost-Benefit Analysis / cost‐effectiveness analysis / Diagnostic Techniques and Procedures / Diagnostic tests / economic evaluation / Economics / Epidermal growth factor / Epidermal growth factor receptors / Expenditures / Humans / Immunotherapy / Keywords / Kinases / Ligands / Lung cancer / Lung Neoplasms - diagnosis / Lung Neoplasms - drug therapy / Lymphoma / Mutation / Non-small cell lung carcinoma / non‐small‐cell lung cancer / Oncology / PD-L1 protein / Pharmacoeconomics / precision diagnostic test / Precision Medicine / Protein-tyrosine kinase / Sarcoma / Sensitivity analysis / Systematic Review