Abstract
Within the European Union, Greece has the highest incidence of lung cancer among people under 45 years of age. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors are indicated for the treatment of patients with EGFR mutation-positive metastatic non-small cell lung cancer (mNSCLC). Tumor tissue biopsy is the standard method for EGFR mutation detection but is invasive, is resource-intensive, and has risks of complications. The objective of this analysis was to estimate the financial impact on the Greek National Health System of adopting plasma biopsy and to identify the cost-optimal approach for EGFR mutation testing of patients with mNSCLC. We developed a budget impact model to estimate total costs for three EGFR mutation testing approaches: (1) plasma test, (2) combined testing (tissue and plasma test), and (3) reflex testing, compared to the current scenario of tissue biopsy only. One-way sensitivity and scenario analyses were conducted to evaluate the impact of uncertainty and variance of different input parameters on the results. In the first-line (1L) setting, base-case results showed that adopting plasma testing in a combined testing approach identified more EGFR mutation-positive patients and yielded cost savings (−€17 per correctly classified patient) relative to tissue testing alone. The reflex testing approach was the cost-optimal strategy in the second-line (2L) setting as it identified the most EGFR mutation-positive patients with cost savings of −€42 per correctly classified patient relative to tissue testing alone. This analysis suggests that access to both EGFR mutation tissue and plasma testing are important for optimizing mNSCLC treatment decisions in Greece. Inclusion of plasma testing in either a combined or reflex testing approach may be cost optimal for EGFR mutation plasma test implementation.
Highlights
Lung cancer is one of the most commonly diagnosed carcinomas globally and accounts for approximately 15% of all cancers in men and 8% among women [1]
Using the referenced data inputs, in the 1L setting, it was estimated that adopting plasma testing in a combined or reflex testing approach enabled more patients to undergo molecular diagnostic testing and identified more epidermal growth factor receptor (EGFR) mutation-positive patients than tissue testing or plasma testing alone
The combined testing approach of primary tissue testing and plasma testing only for patients who are ineligible for tissue biopsy was cost saving relative to tissue testing alone on the basis of each correctly classified patient (−€17)
Summary
Lung cancer is one of the most commonly diagnosed carcinomas globally and accounts for approximately 15% of all cancers in men and 8% among women [1]. Lung cancer accounts for a large proportion (18%) of all cancer-related deaths worldwide which equates to over 1.7 million deaths in. Higher lung cancer prevalence and mortality rates are observed among men in Southern. Within the European Union (EU), Hungary and Serbia have the highest lung cancer mortality rates, while Greece has the highest incidence of lung cancer among people under 45 years of age, attributed to early exposure to cigarettes and smoking [3]. 85–90% of all lung cancer cases are non-small cell lung cancer (NSCLC), with the majority of patients presenting with advanced or metastatic disease at the time of diagnosis [4,5].
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