Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov;41(11):1525-1537.
doi: 10.1007/s40273-023-01291-6. Epub 2023 Jun 25.

Development and Validation of txSim: A Model of Advanced Lung Cancer Treatment in Australia

Preston Ngo  1 , Deme Karikios  2   3 , David Goldsbury  4 , Stephen Wade  4 , Zarnie Lwin  5   6   7 , Brett G M Hughes  5   6   7 , Kwun M Fong  7   8 , Karen Canfell  4 , Marianne Weber  4
Affiliations

Development and Validation of txSim: A Model of Advanced Lung Cancer Treatment in Australia

Preston Ngo et al. Pharmacoeconomics. 2023 Nov.

Abstract

Background and objective: Since 2016, new therapies have transformed the standard of care for lung cancer, creating a need for up-to-date evidence for health economic modelling. We developed a discrete event simulation of advanced lung cancer treatment to provide estimates of survival outcomes and healthcare costs in the Australian setting that can be updated as new therapies are introduced.

Methods: Treatment for advanced lung cancer was modelled under a clinician-specified treatment algorithm for Australia in 2022. Prevalence of lung cancer subpopulations was extracted from cBioPortal and the Sax Institute's 45 and Up Study, a large prospective cohort linked to cancer registrations. All costs were from the health system perspective for the year 2020. Pharmaceutical and molecular diagnostic costs were obtained from public reimbursement fees, while other healthcare costs were obtained from health system costs in the 45 and Up Study. Treatment efficacy was obtained from clinical trials and observational study data. Costs and survival were modelled over a 10-year horizon. Uncertainty intervals were generated with probabilistic sensitivity analyses. Overall survival predictions were validated against real-world studies.

Results: Under the 2022 treatment algorithm, estimated mean survival and costs for advanced lung cancer 10 years post-diagnosis were 16.4 months (95% uncertainty interval [UI]: 14.7-18.1) and AU$116,069 (95% UI: $107,378-$124,933). Survival and costs were higher assuming optimal treatment utilisation rates (20.5 months, 95% UI: 19.1-22.5; $154,299, 95% UI: $146,499-$161,591). The model performed well in validation, with good agreement between predicted and observed survival in real-world studies.

Conclusions: Survival improvements for advanced lung cancer have been accompanied by growing treatment costs. The estimates reported here can be used for budget planning and economic evaluations of interventions across the spectrum of cancer control.

PubMed Disclaimer

Conflict of interest statement

Karen Canfell is a co-principal investigator of an investigator-initiated trial of cervical screening, “Compass”, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity. Compass receives infrastructure support from the Australian government and the ACPCC has received equipment and a funding contribution from Roche Molecular Diagnostics, USA. Karen Canfell is also a co-principal investigator on a major implementation program Elimination of Cervical Cancer in the Western Pacific, which has received support from the Minderoo Foundation and the Frazer Family Foundation and equipment donations from Cepheid Inc. Zarnie Lwin declares participation on advisory boards/scientific advisory committees for, travel support from, and/or honoraria from Pfizer, AstraZeneca, Bristol Myers Squibb and Merck. Kwun M. Fong, David Goldsbury, Brett G.M. Hughes, Deme Karikios, Preston Ngo, Marianne Weber and Stephen Wade have no conflicts of interest that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Simplified structure of the txSim model (A) and simplified treatment algorithm for advanced lung cancer in 2022 (B). ALK anaplastic lymphoma kinase, EGFR epidermal growth factor receptor, BSC best supportive care, CTX-IO chemo-immunotherapy, IO immunotherapy, NSCLC WT wild-type non-small cell lung cancer, OS overall survival, Other/NOS other-specified and not-otherwise-specified lung cancer, PFS progression-free survival, Plat CTX platinum chemotherapy, ROS1 c-ros oncogene 1, SA-CTX single-agent chemotherapy, SCLC small cell lung cancer, ST systemic therapy, TKI tyrosine kinase inhibitor
Fig. 2
Fig. 2
Comparison of txSim predictions against observed survival outcomes in real-world studies for patients with non-small cell lung cancer (NSCLC), unselected non-squamous cell carcinoma (NSCC), squamous cell carcinoma (SCC), small-cell lung cancer (SCLC) and NSCLC receiving immunotherapy (A); patients with NSCLC with epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) alterations (B); and Bland–Altman plot showing agreement in simulated and observed restricted mean survival times [RMST] (C). Estimates of mean absolute percentage error (MAPE) and mean absolute error (MAE) are within each subgroup
Fig. 3
Fig. 3
Model-estimated overall survival (OS) probability in advanced lung cancer subpopulations receiving systemic therapy. ALK anaplastic lymphoma kinase, EGFR epidermal growth factor receptor, NSCC non-squamous cell carcinoma, Other/NOS other-specified or not-otherwise-specified; PD-L1 programmed death ligand 1, ROS1 c-ros oncogene 1, SCC squamous cell carcinoma, SCLC small cell lung cancer
See this image and copyright information in PMC

References

    1. Rosenthal MA, Webster PJ, Stuart-Harris RC, Langlands AO, Boyages J, Gebski VJ. The cost of treating small cell lung cancer. Med J Aust. 1992;156:605–611. doi: 10.5694/j.1326-5377.1992.tb121456.x. - DOI - PubMed
    1. Access Economics. Cost of cancer in NSW: a report by Access Economics Pty Limited for The Cancer Council NSW (2007). Cancer Council NSW. https://www.cancercouncil.com.au/wp-content/uploads/2010/11/costofcancer....
    1. Kang S, Koh E-S, Vinod SK, Jalaludin B. Cost analysis of lung cancer management in South Western Sydney. J Med Imaging Radiat Oncol. 2012;56:235–241. doi: 10.1111/j.1754-9485.2012.02354.x. - DOI - PubMed
    1. Goldsbury DE, Weber MF, Yap S, Rankin NM, Ngo P, Veerman L, et al. Health services costs for lung cancer care in Australia: estimates from the 45 and Up Study. PLoS One. 2020;15:e0238018. doi: 10.1371/journal.pone.0238018. - DOI - PMC - PubMed
    1. Medical Services Advisory Committee. Application No. 1699 National Lung Cancer Screening Program; 2022. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1699-public [Accessed 8 Jun 2023].