title: Could molecular pathology testing in lung cancer be more cost-effective?
abstract: OBJECTIVE
  EGFR and ALK analysis is routinely undertaken prior to targeted treatment of non-squamous non-small cell lung carcinoma (NSCLC). Increasingly, limited resources require molecular pathology services to be cost-effective without detriment to patient care.
  
  
  METHODS
  Data from an audit of molecular pathology testing in the South East Scotland Cancer Network (SCAN) network have been used to explore different testing strategies with the aim of reducing costs; including investigation of thyroid transcription factor 1 (TTF1) expression as a negative predictor for EGFR mutations.
  
  
  RESULTS
  TTF1 immunohistochemistry had a high negative predictive value for EGFR mutations (99%). Reflex testing all non-squamous NSCLC, as expected, had the highest costs, whereas limiting testing to those who might be considered for treatment would lead to a cost reduction of only 7.5%; however, a serial testing model could save 32.7%.
  
  
  CONCLUSIONS
  Testing only patients being considered for EGFR and ALK inhibitors represented small savings; more significant savings would be achievable if testing algorithms used known associations between clinical biomarkers.
authors.affiliation: Department of Molecular Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Kathy
authors.initials: K
authors.lastname: Walsh
authors.affiliation: Department of Molecular Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Yuan Chun
authors.initials: YC
authors.lastname: Kheng
authors.affiliation: Department of Molecular Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Anca
authors.initials: A
authors.lastname: Oniscu
authors.affiliation: Department of Molecular Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK School of Medicine, University of St Andrews, St Andrews, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Harrison
authors.affiliation: Department of Molecular Pathology, Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: William A
authors.initials: WA
authors.lastname: Wallace
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000235:genetics; D003362:Cost-Benefit Analysis; D004268:DNA-Binding Proteins / Q000235:genetics; D066246:ErbB Receptors / Q000235:genetics*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation; D057089:Pathology, Molecular / Q000191:economics*; D012606:Scotland; D014157:Transcription Factors
chemical_list: D004268:DNA-Binding Proteins; C504003:TTF1 protein, human; D014157:Transcription Factors; C512478:EGFR protein, human; D066246:ErbB Receptors
keywords: COSTING & PRICING; LUNG CANCER; MOLECULAR PATHOLOGY