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• W3205799257 abstract "Liquid biopsy (LB) detects targetable alterations in circulating tumour DNA beyond tissue testing alone (TT) in newly diagnosed advanced non-small cell lung cancer (NSCLC) patients. We estimated the cost-effectiveness of adding LB to standard TT in a public system as part of an investigator-initiated trial. A cost-effectiveness analysis was conducted using a decision analytic Markov model from the Canadian public payer (Ontario) perspective and a lifetime horizon in patients with treatment-naïve stage IV non-squamous NSCLC and ≤10 pack-year smoking history. LB was performed using Guardant360TM (G360), with comprehensive genomic profiling of >70 cancer-associated genes. Standard TT included single gene testing for EGFR and ALK and/or limited panel testing. Molecular testing by LB plus TT was compared to TT alone. Transition probabilities were calculated from the investigator-initiated VALUE clinical trial (NCT03576937) for patients that received systemic therapy. Costs from the Princess Margaret Cancer Centre and published literature were used, including costs for targeted therapy, chemo-immunotherapy and repeat tissue biopsy as needed. Sensitivity analyses varied costs, utilities and prevalence of genomic targets to assess uncertainty in the model. Data for the model were derived from 146 stage IV patients, with a median age of 64 (range 23-91), 64% were female and 79% never smokers. Targetable alterations were identified in 68.5% of patients using LB and TT, compared to 52.7% using standard TT alone. For those receiving targeted therapy (N=82), median progression-free survival (PFS) was 11.4 months (95% CI: 8.3 – NR) and median overall survival (OS) was not reached. For those receiving non-targeted therapy (N=48), median PFS and OS were 9.8 months (95% CI: 4.4 – 19.5) and 19.5 months (95% CI: 10.2 – 19.5), respectively. Use of the LB + TT strategy resulted in incremental cost savings of $37,216 (95% CI: $32,158-42,171) per patient and a gain of 0.07 quality-adjusted life-years (95% CI: 0.02-0.12) compared to TT alone. Use of non-proprietary technology may increase savings up to $40,215 CAD (95% CI: $35,220 to 45,304) per patient. Major drivers of cost-effectiveness were drug acquisition costs, LB cost and prevalence of targetable alterations. The use of LB added to TT in the initial diagnosis of clinically selected patients with advanced NSCLC significantly increases the proportion of patients that can access targeted therapy and also reduces costs, primarily by avoiding inappropriate use of chemo-immunotherapy first-line." @default.
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• W3205799257 date "2021-10-01" @default.
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• W3205799257 title "OA16.02 The Economic Value of Liquid Biopsy for Genomic Profiling in Advanced Non-Small Cell Lung Cancer" @default.
• W3205799257 doi "https://doi.org/10.1016/j.jtho.2021.08.087" @default.
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