Cost effectiveness analysis of plasma genotyping versus tumor genotyping in detection of advanced non-small-cell lung cancer with epidermal growth factor receptor and T790M mutation under the Brazilian private healthcare system perspective

Abstract

Cost effectiveness analysis of plasma genotyping versus tumor genotyping in detection of advanced non-small-cell lung cancer with epidermal growth factor receptor and T790M mutation under the Brazilian private healthcare system perspective Custo-efetividade do uso da biópsia líquida versus biópsia tecidual para detecção de câncer de pulmão de não pequenas células avançado com receptor do fator de crescimento epidérmico e mutação T790M sob a perspectiva do sistema suplementar de saúde do Brasil ABSTRACT Objective: Comparing the costs and effectiveness of plasma genotyping versus tumor genotyping for detecting the T790M mutation in advanced non-small cell lung cancer (NSCLC) with a mutation in the epidermal growth factor receptor (EGFR) and that progressed after use of an EGFR tyrosine kinase inhibitor (EGFR-TKI), from the perspective of the private healthcare system in Brazil. Methods: Patients with a post-EGFR-TKI T790M mutation are eligible for a second-line treatment with a third--generation EGFR-TKI (osimertinib). In order to estimate the costs associated with the diagnosis method for the T790M mutation, a decision tree model has been used. Resource use was estimated by a team of experts, and the direct costs were estimated based on official databases. Results: Plasma genotyping provided a R$391 reduction per patient, due to the reduced cost with complications; it prevented 40.96% of the patients from undergoing an invasive procedure and 31.91% of the patients from having any kind of complication. Conclusion: Data found support a new paradigm for treating the resistance to EGFR-TKIs, with plasma genotyping as the first diagnostic choice, what can help to define the treatment and to reduce the costs of Brazilian private healthcare system. Recebido em: 28/08/2018. Aprovado para publicação em: 27/09/2018. 263Cost effectiveness analysis of plasma genotyping for detecting T790M mutation in patients with advanced non-small cell lung cancer in Brazil Análise de custo-efetividade da genotipagem de plasma para detecção da mutação T790M em pacientes com câncer avançado de pulmão de não pequenas células no Brasil J Bras Econ Saúde 2018;10(3): 262-8Cost effectiveness analysis of plasma genotyping for detecting T790M mutation in patients with advanced non-small cell lung cancer in Brazil Análise de custo-efetividade da genotipagem de plasma para detecção da mutação T790M em pacientes com câncer avançado de pulmão de não pequenas células no Brasil J Bras Econ Saúde 2018;10(3): 262-8