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

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

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
23 Downloads (Pure)

Abstract

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). In order to address this gap, we conducted Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 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 thirty-seven (50%) were excluded, having failed population-, intervention-, comparator-, outcomes-, and study-design criteria. Within the thirty-seven studies included, we defined sixty-four scenarios. Eleven scenarios compared PDT-guided PM to 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 to chemotherapy alone [anaplastic lymphoma kinase, n=3; EGFR, n=17; PD-L1, n=8]. Twenty-five scenarios compared PDT-guided PM to chemotherapy alone, while varying the PDT approach. Thirty-four scenarios (53%) were cost-effective, twenty-eight (44%) were not cost-effective, and two were marginal, dependent on their country's WTP threshold. When PDT-guided therapy was compared to a therapy-for-all patients approach, all scenarios (100%) proved cost-effective. Seven of thirty-seven 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.
Original languageEnglish
JournalMolecular oncology
Early online date10 Jun 2021
DOIs
Publication statusEarly online date - 10 Jun 2021

Keywords

  • Economic evaluation
  • biomarker
  • cost-effectiveness analysis
  • non-small-cell lung cancer (NSCLC)
  • precision diagnostic test (PDT)
  • precision medicine

Fingerprint

Dive into the research topics of 'Cost-effectiveness of precision diagnostic testing for precision medicine approaches against non-small-cell lung cancer: a systematic review'. Together they form a unique fingerprint.

Cite this