title: Economic Evaluation of Companion Diagnostic Testing for EGFR Mutations and First-Line Targeted Therapy in Advanced Non-Small Cell Lung Cancer Patients in South Korea.
abstract: BACKGROUND
  As targeted therapy becomes increasingly important, diagnostic techniques for identifying targeted biomarkers have also become an emerging issue. The study aims to evaluate the cost-effectiveness of treating patients as guided by epidermal growth factor receptor (EGFR) mutation status compared with a no-testing strategy that is the current clinical practice in South Korea.
  
  
  METHODS
  A cost-utility analysis was conducted to compare an EGFR mutation testing strategy with a no-testing strategy from the Korean healthcare payer's perspective. The study population consisted of patients with stage 3b and 4 lung adenocarcinoma. A decision tree model was employed to select the appropriate treatment regimen according to the results of EGFR mutation testing and a Markov model was constructed to simulate disease progression of advanced non-small cell lung cancer. The length of a Markov cycle was one month, and the time horizon was five years (60 cycles).
  
  
  RESULTS
  In the base case analysis, the testing strategy was a dominant option. Quality-adjusted life-years gained (QALYs) were 0.556 and 0.635, and total costs were $23,952 USD and $23,334 USD in the no-testing and testing strategy respectively. The sensitivity analyses showed overall robust results. The incremental cost-effectiveness ratios (ICERs) increased when the number of patients to be treated with erlotinib increased, due to the high cost of erlotinib.
  
  
  CONCLUSIONS
  Treating advanced adenocarcinoma based on EGFR mutation status has beneficial effects and saves the cost compared to no testing strategy in South Korea. However, the cost-effectiveness of EGFR mutation testing was heavily affected by the cost-effectiveness of the targeted therapy.
authors.affiliation: College of Pharmacy, Korea University, Sejong, Korea.
authors.forename: Eun-A
authors.initials: EA
authors.lastname: Lim
authors.affiliation: College of Pharmacy, Korea University, Sejong, Korea.
authors.forename: Haeyoung
authors.identifier: http://orcid.org/0000-0002-8259-920X
authors.initials: H
authors.lastname: Lee
authors.affiliation: College of Pharmacy, Korea University, Sejong, Korea.
authors.forename: Eunmi
authors.initials: E
authors.lastname: Bae
authors.affiliation: College of Pharmacy, Korea University, Sejong, Korea.
authors.forename: Jaeok
authors.initials: J
authors.lastname: Lim
authors.affiliation: College of Pharmacy, Seoul National University, Seoul, Korea.
authors.forename: Young Kee
authors.initials: YK
authors.lastname: Shin
authors.affiliation: College of Pharmacy, Korea University, Sejong, Korea.
authors.forename: Sang-Eun
authors.initials: SE
authors.lastname: Choi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D066246:ErbB Receptors / Q000235:genetics*; D000069347:Erlotinib Hydrochloride / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D015870:Gene Expression; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009154:Mutation; D009367:Neoplasm Staging; D057285:Precision Medicine; D047428:Protein Kinase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D056910:Republic of Korea
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors