Lim, Eun-A; Lee, Haeyoung; Bae, Eunmi; Lim, Jaeok; Shin, Young Kee; Choi, Sang-Eun
PloS one
2016NA ; 11 ( 8 ) :e0160155.
PMID : 27483001
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Lim, Eun-A -
Lee, Haeyoung -
Bae, Eunmi -
Lim, Jaeok -
Shin, Young Kee -
Choi, Sang-Eun -
ABSTRACT
BACKGROUND: As targeted therapy becomes increasingly important, diagnostic techniques for identifying targeted biomarkers have also become an emerging issue. The study aims to evaluate the cost-effectiveness of treating patients as guided by epidermal growth factor receptor (EGFR) mutation status compared with a no-testing strategy that is the current clinical practice in South Korea.
METHODS: A cost-utility analysis was conducted to compare an EGFR mutation testing strategy with a no-testing strategy from the Korean healthcare payer's perspective. The study population consisted of patients with stage 3b and 4 lung adenocarcinoma. A decision tree model was employed to select the appropriate treatment regimen according to the results of EGFR mutation testing and a Markov model was constructed to simulate disease progression of advanced non-small cell lung cancer. The length of a Markov cycle was one month, and the time horizon was five years (60 cycles).
RESULTS: In the base case analysis, the testing strategy was a dominant option. Quality-adjusted life-years gained (QALYs) were 0.556 and 0.635, and total costs were $23,952 USD and $23,334 USD in the no-testing and testing strategy respectively. The sensitivity analyses showed overall robust results. The incremental cost-effectiveness ratios (ICERs) increased when the number of patients to be treated with erlotinib increased, due to the high cost of erlotinib. CONCLUSION: Treating advanced adenocarcinoma based on EGFR mutation status has beneficial effects and saves the cost compared to no testing strategy in South Korea. However, the cost-effectiveness of EGFR mutation testing was heavily affected by the cost-effectiveness of the targeted therapy.
Adenocarcinoma/drug therapy/*economics/pathology; Aged; Antineoplastic Agents/*economics/therapeutic use; Carcinoma, Non-Small-Cell Lung/drug therapy/*economics/pathology; Cost-Benefit Analysis; Decision Trees; Erlotinib Hydrochloride/*economics/therapeutic use; Female; Gene Expression; Health Care Costs; Humans; Lung Neoplasms/drug therapy/*economics/pathology; Male; Markov Chains; Middle Aged; Molecular Targeted Therapy; Mutation; Neoplasm Staging; Precision Medicine; Protein Kinase Inhibitors/*economics/therapeutic use; Quality-Adjusted Life Years; Receptor, Epidermal Growth Factor/*genetics; Republic of Korea
MESH
Adenocarcinoma/drug therapy/*economics/pathology, Aged, Antineoplastic Agents/*economics/therapeutic use, Carcinoma, Non-Small-Cell Lung/drug therapy/*economics/pathology, Cost-Benefit Analysis, Decision Trees, Erlotinib Hydrochloride/*economics/therapeutic use, Female, Gene Expression, Health Care Costs, Humans, Lung Neoplasms/drug therapy/*economics/pathology, Male, Markov Chains, Middle Aged, Molecular Targeted Therapy, Mutation, Neoplasm Staging, Precision Medicine, Protein Kinase Inhibitors/*economics/therapeutic use, Quality-Adjusted Life Years, Receptor, Epidermal Growth Factor/*genetics, Republic of Korea
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