Cost-effectiveness analysis of four sampling and genomic testing strategies for patients with advanced non-small-cell lung cancer in Australia.
Summary
This study modeled the cost-effectiveness of various genomic testing strategies for patients with advanced non-small-cell lung cancer (NSCLC) in Australia. It compared combinations of sampling methods (tissue biopsy, liquid biopsy) and molecular tests (single-gene, small, or large panels). Results indicated that large genomic panel strategies, while more expensive, yielded the highest gains in quality-adjusted life years (QALYs). The analysis concluded that these comprehensive genomic testing approaches are potentially cost-effective, despite a notable budget impact on the healthcare system.
Analysis
Clinique: This cost-effectiveness analysis, based on Monte Carlo simulations, suggests that integrating comprehensive genomic testing for advanced NSCLC in Australia is potentially cost-effective. Large panel strategies demonstrated an incremental gain in QALYs (1.82-1.88 QALYs) compared to smaller panels (1.70-1.75 QALYs), with an incremental cost per QALY gained ranging from AU$59,983 to AU$70,840. Although the budget impact could be up to 64% higher than standard care, these findings could justify changes in Australian clinical guidelines, moving towards broader adoption of comprehensive genomic testing. Clinical impact could be seen in the medium term (3-5 years) if these results are integrated into reimbursement policies. Biomol: The study evaluated various sampling and molecular testing options, including tissue biopsies (aspirate, FFPE cell block), cytology smears, and liquid biopsies (cell-free DNA), alongside single-gene, small panel, and large panel tests. The focus is on comparing the efficacy and cost of these different approaches. The use of large genomic panels is highlighted for its potential to identify more therapeutic targets, thereby improving patient outcomes. The flexibility of sample types (FFPE, cytology, cfDNA) is crucial for clinical practice, allowing adaptation in situations where tissue biopsy is challenging.