The economic value of liquid biopsy for genomic profiling in advanced non-small cell lung cancer.

Autor:	Ezeife DA; Department of Oncology, Tom Baker Cancer Center, 1331 29 St NW, Toronto, ON T2N 4N2, Canada University of Calgary, Calgary, AB, Canada., Spackman E; University of Calgary, Calgary, AB, Canada., Juergens RA; Juravinski Cancer Center, McMaster University, Hamilton, ON, Canada., Laskin JJ; BC Cancer, The University of British Columbia, Vancouver, BC, Canada., Agulnik JS; Jewish General Hospital, McGill University, Montreal, QC, Canada., Hao D; Tom Baker Cancer Center, Calgary, AB, Canada University of Calgary, Calgary AB, Canada., Laurie SA; Ottawa Hospital Research Institute/Department of Medicine, University of Ottawa, Ottawa, ON, Canada., Law JH; Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Le LW; Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Kiedrowski LA; Guardant Health, Inc., Redwood City, CA, Canada., Melosky B; BC Cancer, The University of British Columbia, Vancouver, BC, Canada., Shepherd FA; Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Cohen V; Jewish General Hospital, McGill University, Montreal, QC, Canada., Wheatley-Price P; Ottawa Hospital Research Institute/Department of Medicine, University of Ottawa, Ottawa, ON, Canada., Vandermeer R; Niagara Health, St. Catharines, ON, Canada., Li JJ; Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Fernandes R; Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Shokoohi A; BC Cancer, The University of British Columbia, Vancouver, BC, Canada., Lanman RB; Guardant Health, Inc., Redwood City, CA, Canada., Leighl NB; Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	Therapeutic advances in medical oncology [Ther Adv Med Oncol] 2022 Jul 26; Vol. 14, pp. 17588359221112696. Date of Electronic Publication: 2022 Jul 26 (Print Publication: 2022).
DOI:	10.1177/17588359221112696
Abstrakt:	Background: Liquid biopsy (LB) can detect actionable genomic alterations in plasma circulating tumor circulating tumor DNA beyond tissue testing (TT) alone in advanced non-small cell lung cancer (NSCLC) patients. We estimated the cost-effectiveness of adding LB to TT in the Canadian healthcare system. Methods: A cost-effectiveness analysis was conducted using a decision analytic Markov model from the Canadian public payer (Ontario) perspective and a 2-year time horizon in patients with treatment-naïve stage IV non-squamous NSCLC and ⩽10 pack-year smoking history. LB was performed using the comprehensive genomic profiling Guardant360™ assay. Standard of care TT for each participating institution was performed. Costs and outcomes of molecular testing by LB + TT were compared to TT alone. Transition probabilities were calculated from the VALUE trial (NCT03576937). Sensitivity analyses were undertaken to assess uncertainty in the model. Results: Use of LB + TT identified actionable alterations in more patients, 68.5 versus 52.7% with TT alone. Use of the LB + TT strategy resulted in an incremental cost savings of $3065 CAD per patient (95% CI, 2195-3945) and a gain in quality-adjusted life-years of 0.02 (95% CI, 0.01-0.02) versus TT alone. More patients received chemo-immunotherapy based on TT with higher overall costs, whereas more patients received targeted therapy based on LB + TT with net cost savings. Major drivers of cost-effectiveness were drug acquisition costs and prevalence of actionable alterations. Conclusion: The addition of LB to TT as initial molecular testing of clinically selected patients with advanced NSCLC did not increase system costs and led to more patients receiving appropriate targeted therapy. Competing Interests: Competing Interests: The authors declare that there is no conflict of interest. (© The Author(s), 2022.)
Databáze:	MEDLINE
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