Researchers have developed a prognostic test to direct adjuvant chemotherapy (ACT) decision in early-stage non-small cell lung cancer (NSCLC) adenocarcinomas. The purpose of their study was to weigh up the cost-utility of the prognostic test to the present standard of care (SoC) in patients with early-stage NSCLC. They examined the lifetime costs (2014 U.S. dollars) and effectiveness (quality-adjusted life-years [QALYs]) of ACT treatment decisions. They used a Markov microsimulation model from a U.S. third-party payer perspective to do so. The researchers distributed the cancer stage and attributed the probability of receiving ACT with SoC based on data from an academic cancer center. They estimated the probability of receiving ACT with the prognostic test from a physician survey, and they classified the risks based on the 5-year predicted NSCLC-related mortality. The benefits of treatment with adjuvant chemotherapy were dependent on the prognostic score. They also chose to apply a discounting of a 3% annual rate to costs and QALYs. Plus, they examined parameter uncertainty using deterministic one-way and probabilistic sensitivity analyses.

The researchers calculated 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 small increase in the cost-effectiveness ratio for the prognostic test versus the SoC was a gain of $35,867 per QALY. One-way sensitivity analyses revealed the model was most sensitive to the patients’ utility without recurrence after ACT and the ACT treatment benefit. On the other hand, probabilistic sensitivity analysis suggested that the prognostic test was cost-effective in 65.5% of simulations.

They concluded that utilizing a prognostic test to guide ACT decisions in early-stage NSCLC is possibly cost-effective compared with using the SoC based on globally accepted willingness-to-pay thresholds.

Link:theoncologist.onlinelibrary.wiley.com/doi/10.1634/theoncologist.2015-0162