The economic value of liquid biopsy for genomic profiling in advanced non-small cell lung cancer

Abstract

Background: Liquid biopsy (LB) can detect actionable genomic alterations in plasma circulating tumor circulating tumor DNA beyond tissue testing (TT) alone in advanced non-small cell lung cancer (NSCLC) patients. We estimated the cost-effectiveness of adding LB to TT in the Canadian healthcare system.

Methods: A cost-effectiveness analysis was conducted using a decision analytic Markov model from the Canadian public payer (Ontario) perspective and a 2-year time horizon in patients with treatment-naïve stage IV non-squamous NSCLC and ⩽10 pack-year smoking history. LB was performed using the comprehensive genomic profiling Guardant360™ assay. Standard of care TT for each participating institution was performed. Costs and outcomes of molecular testing by LB + TT were compared to TT alone. Transition probabilities were calculated from the VALUE trial (NCT03576937). Sensitivity analyses were undertaken to assess uncertainty in the model.

Results: Use of LB + TT identified actionable alterations in more patients, 68.5 versus 52.7% with TT alone. Use of the LB + TT strategy resulted in an incremental cost savings of $3065 CAD per patient (95% CI, 2195-3945) and a gain in quality-adjusted life-years of 0.02 (95% CI, 0.01-0.02) versus TT alone. More patients received chemo-immunotherapy based on TT with higher overall costs, whereas more patients received targeted therapy based on LB + TT with net cost savings. Major drivers of cost-effectiveness were drug acquisition costs and prevalence of actionable alterations.

Conclusion: The addition of LB to TT as initial molecular testing of clinically selected patients with advanced NSCLC did not increase system costs and led to more patients receiving appropriate targeted therapy.

Keywords: cost-effectiveness; economic analysis; liquid biopsy; non-small cell lung cancer; targeted therapy.

Figure 1.

(a) Decision tree. M indicates movement into the Markov model. LB, liquid biopsy; TT, tumor tissue biopsy. (b) Markov model for patients receiving targeted therapy. (c) Markov model for patients receiving chemo-immunotherapy.

Figure 2.

Cost of tissue plus liquid biopsy compared to cost of tissue biopsy alone. Costs in 2022 $CAD.

Figure 3.

Incremental cost tornado diagram. Costs and utilities are monthly, and costs are in valued in 2022 $CAD. BSC, best supportive care; chemoIO, chemo-immunotherapy; PF, progression-free; TST15, TruSight Tumor 15 panelTM. Note: a negative incremental cost indicates a cost savings (LB + TT less costly than TT alone); a positive incremental cost indicates a cost increase (LB + TT more costly than TT alone).

Figure 4.

One-way sensitivity analysis of cost of chemo-immunotherapy. Costs are monthly costs in 2022 $CAD. cChemoIO, cost of chemo-immunotherapy; Bx, biopsy.