A comparison of individualized treatment guided by VeriStrat with standard of care treatment strategies in patients receiving second-line treatment for advanced non-small cell lung cancer: A cost-utility analysis.
OBJECTIVE
Two therapies are appropriate as 2nd-line treatment of non-small cell lung cancer (NSCLC) patients: chemotherapy and epidermal growth factor receptor (EGFR) inhibitor therapy. VeriStrat, a serum proteomic test, can be used to guide treatment decisions for NSCLC patients. The test classifies patients as likely to benefit from either of these two treatment options. The objective of this research was to model the anticipated survival and cost-effectiveness of four different treatment strategies: chemotherapy for all patients (C-all), EGFR inhibitor for all (E-all), a performance status guided selection strategy (PS-guided), and a strategy guided by VeriStrat test results (V-guided).


METHODS
We developed a Markov model with the perspective of the U.S. health care system. Model inputs were taken from published literature for the base-case analysis. One-way and probabilistic sensitivity analyses were performed.


CONCLUSIONS
The C-all treatment strategy showed the best overall survival outcome (10.1 months), followed by V-guided (9.6 months), PS-guided (9.2 months), and E-all (8.2 months) strategies. The incremental cost-effectiveness ratio (ICER) of a V-guided treatment strategy was $91,111 (vs. E-all) and $8462 (vs. PS-guided) per quality-adjusted life year (QALY). The ICER for C-all compared to V-guided was $105,616. This cost-utility analysis indicates that a treatment strategy guided by the VeriStrat test in patients receiving second-line therapy for NSCLC may experience an overall survival benefit at an incremental cost-effectiveness ratio that is reasonable when compared with other practices, including cancer treatments, generally covered in the U.S. health care system. However, treating all patients with chemotherapy yielded the greatest expected survival.
VA Salt Lake City Health Care System, Salt Lake City, UT, United States; University of Utah School of Medicine, Salt Lake City, UT, United States. Electronic address: Richard.Nelson@utah.edu.
Richard E
RE
Nelson
David
D
Stenehjem
Wallace
W
Akerley
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D003131:Combined Modality Therapy / Q000191:economics; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D003658:Decision Making, Computer-Assisted; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D057285:Precision Medicine; D011379:Prognosis; D040901:Proteomics; D011933:Reagent Kits, Diagnostic / Q000706:statistics & numerical data; D059039:Standard of Care / Q000706:statistics & numerical data; D016019:Survival Analysis
D000970:Antineoplastic Agents; D011933:Reagent Kits, Diagnostic; C512478:EGFR protein, human; D066246:ErbB Receptors
Cost-utility analysis; Epidermal growth factor receptor inhibitor; Markov model; Non-small cell lung cancer; Second-line treatment; VeriStrat