Cost-Effectiveness of Tumor Genomic Profiling to Guide First-Line Targeted Therapy Selection in Patients With Metastatic Lung Adenocarcinoma.
Cost-Effectiveness of Tumor Genomic Profiling to Guide First-Line Targeted Therapy Selection in Patients With Metastatic Lung Adenocarcinoma.
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DOI：
10.1016/j.jval.2021.09.017
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发表时间：
2022-04
期刊：
影响因子：
--
通讯作者：
Voora D
中科院分区：
文献类型：
--
作者：
Dong OM;Poonnen PJ;Winski D;Reed SD;Vashistha V;Bates J;Kelley MJ;Voora D
从医疗保险和医疗补助服务中心的角度，对转移性肺腺癌患者进行了成本-效果分析，比较了10个癌基因的综合基因组图谱(CGP)、4个癌基因的靶向基因小组测试(TGPT)以及终身无肿瘤图谱。一个决策分析模型使用了10,000名患有转移性肺腺癌的假想的联邦医疗保险受益人来模拟与CGP(ALK、BRAF、EGFR、ERBB2、MET、NTRK1、NTRK2、NTRK3、RET、ROS1)、TGPT(ALK、BRAF、EGFR、ROS1)和没有肿瘤特征(没有测试基因)相关的结果。如果检测到可操作的基因变异，则分配一线靶向癌症治疗；否则，分配非靶向癌症治疗。模型输入来自随机试验(无进展生存，不良事件)，退伍军人健康管理局(VHA)和联邦医疗保险(药品成本)，已发表的研究(非药物癌症相关的管理成本，健康状态公用事业)，已发表的数据库(可操作的变异流行)。成本(2019美元)和质量调整生命年(QALY)以每年3%的折扣计算。概率敏感性分析(PSA)使用了1,000个蒙特卡罗模拟。无肿瘤特征分析是人均费用最低的(TGPT为122,613美元比184,063美元，CGP为188,425美元)，人均QALYs最低(TGPT为0.53比0.73，CGP为0.74)。TGPT和非TGPT获得的每QALY成本和相应的95%CI分别为310,735美元(278,323-347,952美元)和445,545美元(322,297-572,084美元)。两个比较的所有PSA模拟都超过了愿意支付的门槛(每QALY增加150,000美元)。在转移性肺腺癌患者中，与没有肿瘤特征的患者相比，肿瘤特征(TGPT，CGP)提高了质量调整后的生存率，但不具有成本效益。与没有肿瘤基因组图谱相比，肿瘤基因组图谱指导转移性肺腺癌患者一线抗癌靶向治疗的选择是不划算的。
A cost-effectiveness analysis comparing comprehensive genomic profiling (CGP) of 10 oncogenes, targeted gene panel testing (TGPT) of 4 oncogenes, and no tumor profiling over the lifetime for patients with metastatic lung adenocarcinoma from the Centers for Medicare and Medicaid Services’ perspective was conducted. A decision analytic model used 10,000 hypothetical Medicare beneficiaries with metastatic lung adenocarcinoma to simulate outcomes associated with CGP (ALK, BRAF, EGFR, ERBB2, MET, NTRK1, NTRK2, NTRK3, RET, ROS1), TGPT (ALK, BRAF, EGFR, ROS1), and no tumor profiling (no genes tested). First-line targeted cancer-directed therapies were assigned if actionable gene variants were detected; otherwise, non-targeted cancer-directed therapies were assigned. Model inputs were derived from randomized trials (progression-free survival, adverse events), the Veterans Health Administration (VHA) and Medicare (drug costs), published studies (non-drug cancer-related management costs, health state utilities), published databases (actionable variant prevalences). Costs (2019 US$) and quality-adjusted life years (QALYs) were discounted at 3% per year. Probabilistic sensitivity analyses (PSA) used 1,000 Monte Carlo simulations. No tumor profiling was the least costly/person ($122,613 vs $184,063 for TGPT and $188,425 for CGP), and yielded the least QALYs/person (0.53 vs 0.73 for TGPT and 0.74 for CGP). The costs/QALY gained and corresponding 95% CI were $310,735 ($278,323-$347,952) for TGPT vs no tumor profiling and $445,545 ($322,297-$572,084) for CGP vs TGPT. All PSA simulations for both comparisons surpassed the willingness-to-pay threshold ($150,000/QALY gained). Compared to no tumor profiling in patients with metastatic lung adenocarcinoma, tumor profiling (TGPT, CGP) improves quality-adjusted survival but is not cost-effective. Compared to no tumor genomic profiling, tumor genomic profiling directing selection of first-line anticancer targeted therapies for patients with metastatic lung adenocarcinoma is not cost-effective.
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影响因子：
51.1
作者：
Drilon, Alexander;Rekhtman, Natasha;Arcila, Maria;Wang, Lu;Ni, Andy;Albano, Melanie;Van Voorthuysen, Martine;Somwar, Romel;Smith, Roger S.;Montecalvo, Joseph;Plodkowski, Andrew;Ginsberg, Michelle S.;Riely, Gregory J.;Rudin, Charles M.;Ladanyi, Marc;Kris, Mark G.
通讯作者：
Kris, Mark G.
影响因子：
3.6
作者：
Labbe, Catherine;Leung, Yvonne;Howell, Doris
通讯作者：
Howell, Doris
影响因子：
50.5
作者：
Lee, S. -H.;Lee, J. -K.;Park, K.
通讯作者：
Park, K.
影响因子：
4.5
作者：
Levy, Joseph;Rosenberg, Marjorie;Vanness, David
通讯作者：
Vanness, David
影响因子：
5.6
作者：
Kamps R;Brandão RD;Bosch BJ;Paulussen AD;Xanthoulea S;Blok MJ;Romano A
通讯作者：
Romano A