Steuten Lotte, Goulart Bernardo, Meropol Neal J, Pritchard Daryl, Ramsey Scott D
Fred Hutchinson Cancer Research Center, Seattle, WA.
Seattle Cancer Care Alliance, Seattle, WA.
JCO Clin Cancer Inform. 2019 Jun;3:1-10. doi: 10.1200/CCI.19.00002.
Compared with single-marker genetic testing (SMGT), multigene panel sequencing (MGPS) has the potential to identify more patients with cancer who could benefit from targeted therapies, but the effects on outcome and total cost of care are uncertain. Our goal was to estimate the clinical and cost effectiveness of MGPS versus SMGT among patients with advanced non-small-cell lung cancer (aNSCLC).
Patients with aNSCLC-stage IIIB or metastatic-who were diagnosed between 2011 and 2016 were identified from the Flatiron Health database. After stratifying patients into MGPS or SMGT cohorts, we analyzed the percentage of patients who received targeted treatment, survival, and total costs of care. SMGT included epidermal growth factor receptor () and anaplastic lymphoma kinase testing. MGPS also allowed for the detection of mutations. Cost data sources were the Centers for Medicare & Medicaid Services Fee Schedule and 2017 average sales price drug cost. We estimated the incremental cost-effectiveness ratio from a US payer perspective over a lifetime horizon using a decision model.
We identified 5,688 patients with aNSCLC who received MGPS (n = 875) or SMGT (n = 4,813), of which 22% tested positive for epidermal growth factor receptor (18.5% MGPS; 17.3% SMGT) or anaplastic lymphoma kinase (3.59% MGPS; 3.78% SMGT). Among MGPS-tested patients, an additional 8% were found to have mutations. Of MGPS-tested patients, 21% received treatments that were targeted to the specific mutations versus 19% with SMGT. Expected survival was 1.14 life years (LYs) in SMGT versus 1.20 LYs in MGPS. Lifetime total costs were $8,814 higher per patient for MGPS. The incremental cost-effectiveness ratio of MGPS versus SMGT was $148,478 per LY gained.
On the basis of data from a nationwide oncology patient database, MGPS is shown to have moderate cost effectiveness compared with SMGT in patients with aNSCLC.
与单标记基因检测（SMGT）相比，多基因panel测序（MGPS）有潜力识别出更多能从靶向治疗中获益的癌症患者，但对治疗结果和总护理成本的影响尚不确定。我们的目标是评估MGPS与SMGT在晚期非小细胞肺癌（aNSCLC）患者中的临床和成本效益。
从Flatiron Health数据库中识别出2011年至2016年间诊断为aNSCLC（ⅢB期或转移性）的患者。在将患者分层为MGPS或SMGT队列后，我们分析了接受靶向治疗的患者百分比、生存率和总护理成本。SMGT包括表皮生长因子受体（）和间变性淋巴瘤激酶检测。MGPS还可检测 突变。成本数据来源是医疗保险和医疗补助服务中心费用表以及2017年药品平均销售价格成本。我们使用决策模型从美国支付方的角度估计了终身范围内的增量成本效益比。
我们识别出5688例接受MGPS（n = 875）或SMGT（n = 4813）的aNSCLC患者，其中22%的患者表皮生长因子受体检测呈阳性（MGPS组为18.5%；SMGT组为17.3%）或间变性淋巴瘤激酶检测呈阳性（MGPS组为3.59%；SMGT组为3.78%）。在接受MGPS检测的患者中，另外8%被发现有 突变。在接受MGPS检测的患者中，21%接受了针对特定突变的治疗，而接受SMGT检测的患者这一比例为19%。SMGT组的预期生存期为1.14生命年（LYs），MGPS组为1.20 LYs。MGPS组每位患者的终身总成本高出8814美元。MGPS与SMGT相比的增量成本效益比为每获得1 LY为148478美元。
基于全国肿瘤患者数据库的数据，在aNSCLC患者中，与SMGT相比，MGPS显示出适度的成本效益。
