Abstract

Objectives: To identify parameters that drive the cost-effectiveness of precision medicine by comparing the use of multiplex targeted sequencing (MTS) to select targeted therapy based on tumour genomic profiles to either no further testing with chemotherapy or no further testing with best supportive care in the last-line treatment of metastatic lung adenocarcinoma.

Materials and Methods: A combined decision tree and Markov model was developed to compare costs, life-years (LYs), and quality-adjusted life-years (QALYs) over a five-year time horizon from an Australian healthcare payer perspective. The published literature and a population-based molecular cohort study (Cancer 2015) were used as the main sources of data. Parameter uncertainty was assessed using deterministic sensitivity analyses and value of information analyses, while uncertainty due to technological/scientific advancement was assessed by conducting a number of plausible future scenario analyses.

Results: Given the current evidence base, the cost-effectiveness of MTS is questionable for selecting targeted therapy in the last-line treatment of metastatic lung adenocarcinoma. Reduced costs of off-label targeted therapy, lower health state utility values for progressive disease, and targeted therapy resulting in reductions in outpatient, emergency, and inpatient visits, however, all resulted in more favourable cost-effectiveness estimates for MTS . The expected value to decision makers of removing all current decision uncertainty was estimated to be $12,890,000, indicating that additional research to reduce parameter uncertainty may be a worthwhile investment. Future scenarios analyses revealed that reducing test turn-around-time improved the cost-effectiveness of MTS , whereas decreasing sequencing costs had little impact. For MTS to have an incremental cost-effectiveness ratio of $100,000/QALY, 50% of identified mutations have to be actionable when off-label targeted therapy costs $1500/week and 100% of patients tested have a mutation identified.

Conclusion: An iterative process to the economic evaluation of MTS will be necessary as our understanding of its impact on health outcomes and the health budget improves.