Cost-effectiveness of KRAS, EGFR and ALK testing for therapeutic decision making of advanced stage non-small cell lung cancer (NSCLC): the French IFCT-PREDICT.amm study

Date

09 Oct 2016

Session

NSCLC, metastatic

Presenters

A Drezet

Citation

Annals of Oncology (2016) 27 (6): 416-454. 10.1093/annonc/mdw383

Authors

A. Drezet¹, S. Loubière¹, M. Wislez², M. Beau-Faller³, I. Nanni-Métellus⁴, S. Garcia⁵, M. Chenard⁶, J. Ghnassia⁷, R. Lacave⁸, M. Antoine⁹, M. Duruisseaux¹⁰, S. Friard¹¹, E. Fabre¹², C. Daniel¹³, P. Missy¹⁴, F. Morin¹⁴, F. Barlesi¹⁵, P. Auquier¹⁶, J. Cadranel²

Author affiliations

¹ Unité D’aide Méthodologique à La Recherche Clinique Et évaluation Médico-économique, Assistance Publique Hôpitaux de Marseille, 13000 - Marseille/FR
² Pneumology, APHP, CancerEst, Tenon University Hospital, 75020 - Paris/FR
³ Pneumologie, C.H.U. Strasbourg-Nouvel Hopital Civil, 67000 - Strasbourg/FR
⁴ Laboratoire De Transfert D'oncologie Biologique, Aix-Marseille University - Faculté de Médecine Nord, Marseille/FR
⁵ Hôpital Nord, Service D'anatomie Pathologique, Assistance Publique Hôpitaux de Marseille, Marseille/FR
⁶ Département De Pathologie, C.H.U. Hautepierre, Strasbourg/FR
⁷ Département De Biologie Et Pathologie, Centre Paul Strauss Centre de Lutte contre le Cancer, Strasbourg/FR
⁸ Biology, APHP, CancerEst, Tenon University Hospital, Paris/FR
⁹ Pathology, APHP, CancerEst, Tenon University Hospital, 75020 - Paris/FR
¹⁰ Pneumologie, CHU Grenoble - Hopital Michallon, Grenoble/FR
¹¹ Pneumologie, Hopital Foch, Suresnes/FR
¹² Medical Oncology, Hopital Europeen Georges Pompidou, Paris/FR
¹³ Pneumologie, Institut Curie, Paris/FR
¹⁴ Clinical Research Unit, IFCT (Intergroupe Francophone de Cancérologie Thoracique)., 75009 - PARIS/FR
¹⁵ Multidisciplinary Oncology And Therapeutic Innovations Department, Aix-Marseille University - Faculté de Médecine Nord, Marseille/FR
¹⁶ Laboratoire De Santé Publique, Assistance Publique Hôpitaux de Marseille, Marseille/FR

Resources

Abstract 3933

Background

Knowledge of molecular status improves the clinical benefit of targeted therapies. ALK rearrangement and EGFR/KRAS mutation are the main biomarkers tested to deliver or not targeted therapies in advanced NSCLC, but their economic impact has not been studied in large prospective cohorts. One objective of the IFCT-PREDICT.amm study was to evaluate the incremental cost-effectiveness ratio (ICER) of a strategy including the knowledge of at least one biomarker status at first- or second-line and the most appropriate treatment (intervention strategy) compared with the standard of care without biomarker testing (reference strategy).

Methods

A cost-effectiveness analysis was performed based on prospective individual data from 802 previously never treated French patients with advanced stage of NSCLC included between 01/2013 and 02/2014 in the IFCT-PREDICT.amm study. Overall survival (OS) during both first- and second-line and direct medical costs related to treatment, inpatient care and biomarker testing from the French payer perspective were valued. A propensity score matching was performed to compare patients with same baseline characteristics (n = 308). Probabilistic sensitivity analyses were performed to test the robustness of the results.

Results

A total of 647 patients received the intervention strategy. The incremental OS in the intervention strategy group was 6 months (p

Conclusions

Molecular testing before first- or second-line treatment initiation result in better survival with limited additional costs, validating it is a cost effective alternative in NSCLC management. These results can help decision maker to define conditions for appropriate diffusion of these technological innovations in general practices.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

INCa, Roche, Boeringher Ingelheim, Lilly

Disclosure

All authors have declared no conflicts of interest.

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