title: Cost-Utility of a Prognostic Test Guiding Adjuvant Chemotherapy Decisions in Early-Stage Non-Small Cell Lung Cancer.
abstract: BACKGROUND
  A prognostic test was developed to guide adjuvant chemotherapy (ACT) decisions in early-stage non-small cell lung cancer (NSCLC) adenocarcinomas. The objective of this study was to compare the cost-utility of the prognostic test to the current standard of care (SoC) in patients with early-stage NSCLC.
  
  
  METHODS
  Lifetime costs (2014 U.S. dollars) and effectiveness (quality-adjusted life-years [QALYs]) of ACT treatment decisions were examined using a Markov microsimulation model from a U.S. third-party payer perspective. Cancer stage distribution and probability of receiving ACT with the SoC were based on data from an academic cancer center. The probability of receiving ACT with the prognostic test was estimated from a physician survey. Risk classification was based on the 5-year predicted NSCLC-related mortality. Treatment benefit with ACT was based on the prognostic score. Discounting at a 3% annual rate was applied to costs and QALYs. Deterministic one-way and probabilistic sensitivity analyses examined parameter uncertainty.
  
  
  RESULTS
  Lifetime costs and effectiveness were $137,403 and 5.45 QALYs with the prognostic test and $127,359 and 5.17 QALYs with the SoC. The resulting incremental cost-effectiveness ratio for the prognostic test versus the SoC was $35,867/QALY gained. One-way sensitivity analyses indicated the model was most sensitive to the utility of patients without recurrence after ACT and the ACT treatment benefit. Probabilistic sensitivity analysis indicated the prognostic test was cost-effective in 65.5% of simulations at a willingness to pay of $50,000/QALY.
  
  
  CONCLUSIONS
  The study suggests using a prognostic test to guide ACT decisions in early-stage NSCLC is potentially cost-effective compared with using the SoC based on globally accepted willingness-to-pay thresholds.
  
  
  CONCLUSIONS
  Providing prognostic information to decision makers may help some patients with high-risk early stage non-small cell lung cancer receive appropriate adjuvant chemotherapy while avoiding the associated toxicities and costs in patients with low-risk disease. This study used an economic model to assess the effectiveness and costs associated with using a prognostic test to guide adjuvant chemotherapy decisions compared with the current standard of care in patients with non-small cell lung cancer. When compared with current standard care, the prognostic test was potentially cost effective at commonly accepted thresholds in the U.S. This study can be used to help inform decision makers who are considering using prognostic tests.
authors.affiliation: Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA Huntsman Cancer Institute, University of Utah Hospitals & Clinics, Salt Lake City, Utah, USA David.stenehjem@hsc.utah.edu.
authors.forename: David D
authors.initials: DD
authors.lastname: Stenehjem
authors.affiliation: Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA SelectHealth, Salt Lake City, Utah, USA.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Bellows
authors.affiliation: Myriad Genetics, Inc., Salt Lake City, Utah, USA.
authors.forename: Kraig M
authors.initials: KM
authors.lastname: Yager
authors.affiliation: Myriad Genetics, Inc., Salt Lake City, Utah, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Jones
authors.affiliation: Myriad Genetics, Inc., Salt Lake City, Utah, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kaldate
authors.affiliation: Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria Area 4 Health Technology Assessment and Bioinformatics, Oncotyrol Center for Personalized Cancer Medicine, Innsbruck, Austria Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, USA Cardiovascular Research Program, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.affiliation: Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA Program in Personalized Health, University of Utah, Salt Lake City, Utah, USA Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria Area 4 Health Technology Assessment and Bioinformatics, Oncotyrol Center for Personalized Cancer Medicine, Innsbruck, Austria.
authors.forename: Diana I
authors.initials: DI
authors.lastname: Brixner
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics / Q000453:epidemiology* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003362:Cost-Benefit Analysis; D006801:Humans; D018803:Models, Economic; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D019057:Quality-Adjusted Life Years
keywords: Cost-effectiveness analysis; Cost-utility analysis; Economic analysis; Non-small cell lung cancer; Prognostic test