Abstract 1361P
Background
Characterization of specific genomic alterations is needed prior to treat advanced lung cancer patients. Determination of ALK rearrangements in advanced non-small cell lung cancer (NSCLC), along with EGFR, ROS1, BRAF or PD-L1 analysis, is mandatory for an adequate treatment decision. The aim of this study is to determine the clinical and economic impact of current ALK testing and treatment scenarios in Spain.
Methods
A hybrid decision-analytic model was developed to estimate the cost and health outcomes of NSCLC patients comparing the current testing scenario vs a no-testing scenario. Current distribution of ALK testing techniques and the sensitivity and specificity data were retrieved from the literature. Target treatments were based on expert opinion and test results. For each treatment, a 3-states Markov model was developed, where progression-free survival (PFS) and overall survival (OS) curves were parameterized using exponential extrapolations to model transition of patients among health states (lifetime horizon). A Spanish Health System perspective was used and 3% discount rate applied. Deterministic and probabilistic sensitivity analyses were performed to address uncertainty.
Results
A target population of 7,628 NSCLC (non-squamous and never-smoker squamous) patients per year was estimated. Over a lifetime horizon, the current ALK testing scenario produced an additional 5,060 life years (LYs) and 3,906 quality-adjusted life-years (QALYs) compared with the no-testing scenario. The incremental cost-effectiveness ratio (ICER) was 13.136 €/QALY. Further parameters were measured such as median cost and median QALYs of the four possible test results plus no tested patients. The sensitivity analyses carried out confirmed the robustness of the base-case results, with the sensitivity and specificity variables being the key drivers of the model.
Conclusions
ALK testing in non-squamous and never-smoker squamous NSCLC patients is a cost-effective strategy, which generates more than 3,000 QALYs in Spain over a lifetime horizon. Comparing this gain in health outcomes with the incremental costs (associated mainly with targeted treatments), the resulting ICER shows that testing non-squamous and never-smoker squamous NSCLC is a cost-effective strategy in Spain.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Roche Farma S.A.
Funding
Roche Farma S.A.
Disclosure
L. Cabezón Gutiérrez: Advisory/Consultancy: Angelini; Advisory/Consultancy: Grunenthal; Advisory/Consultancy: Kyowa Kirin; Advisory/Consultancy: Mudipharma; Advisory/Consultancy: Pfizer; Advisory/Consultancy: Rovi; Advisory/Consultancy: Leo Pharma; Advisory/Consultancy: Merck Serono; Advisory/Consultancy: Ipsen Pharma; Advisory/Consultancy: AstraZeneca. E. Nadal: Advisory/Consultancy: Bristol-Myers Squibb; Advisory/Consultancy: Merck Sharpe & Dohme; Advisory/Consultancy: Lilly; Advisory/Consultancy: Pfizer; Advisory/Consultancy: Takeda; Advisory/Consultancy: Boehringer Ingelheim; Advisory/Consultancy: Amgen; Advisory/Consultancy: AstraZeneca. D. Bautista: Advisory/Consultancy: AbbVie; Advisory/Consultancy: MSD; Advisory/Consultancy: AstraZeneca. F. Rojo Todo: Advisory/Consultancy: Pfizer; Advisory/Consultancy: MSD; Advisory/Consultancy: Bristol-Myers; Advisory/Consultancy: Merck; Advisory/Consultancy: Novartis; Advisory/Consultancy: AstraZeneca; Advisory/Consultancy: Genomic Health; Advisory/Consultancy: Bayer. L. Ruiz De Alda, F. Garcia, P. Vieitez: Full/Part-time employment: Roche Farma. D. Carcedo: Full/Part-time employment, Consultant, not full-time employee of Roche: Roche Farma. All other authors have declared no conflicts of interest.