The economic value of liquid biopsy for genomic profiling in advanced non-small cell lung cancer

Abstract

Background: Liquid biopsy (LB) can detect actionable genomic alterations in plasma circulating tumor circulating tumor DNA beyond tissue testing (TT) alone in advanced non-small cell lung cancer (NSCLC) patients. We estimated the cost-effectiveness of adding LB to TT in the Canadian healthcare system. Methods: A cost-effectiveness analysis was conducted using a decision analytic Markov model from the Canadian public payer (Ontario) perspective and a 2-year time horizon in patients with treatment-naïve stage IV non-squamous NSCLC and ⩽10 pack-year smoking history. LB was performed using the comprehensive genomic profiling Guardant360™ assay. Standard of care TT for each participating institution was performed. Costs and outcomes of molecular testing by LB + TT were compared to TT alone. Transition probabilities were calculated from the VALUE trial (NCT03576937). Sensitivity analyses were undertaken to assess uncertainty in the model. Results: Use of LB + TT identified actionable alterations in more patients, 68.5 versus 52.7% with TT alone. Use of the LB + TT strategy resulted in an incremental cost savings of $3065 CAD per patient (95% CI, 2195–3945) and a gain in quality-adjusted life-years of 0.02 (95% CI, 0.01–0.02) versus TT alone. More patients received chemo-immunotherapy based on TT with higher overall costs, whereas more patients received targeted therapy based on LB + TT with net cost savings. Major drivers of cost-effectiveness were drug acquisition costs and prevalence of actionable alterations. Conclusion: The addition of LB to TT as initial molecular testing of clinically selected patients with advanced NSCLC did not increase system costs and led to more patients receiving appropriate targeted therapy.

Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

“…Other studies have analyzed the use of LB for risk assessment of patients living with advanced cancers. [46][47][48] To our knowledge, this is the first study that also considers novel LB in a cost-effectiveness analysis for CRC screening.…”

“…Our analysis focuses on a new category of blood-based screening tests that could have better performance with the advent of efficient next-generation sequencing and application of artificial intelligence for cancer prediction. Other studies have analyzed the use of LB for risk assessment of patients living with advanced cancers . To our knowledge, this is the first study that also considers novel LB in a cost-effectiveness analysis for CRC screening.…”

Re‐re‐biopsy? How much tumor is enough in the era of precision oncology?

“…Variable factors include access to tissue biopsy procedures; availability of liquid biopsy; associated laboratory requirements of tissue and liquid biopsy; national reimbursement programs of targeted therapies; and availability of clinical trials. A Canadian cost‐effectiveness analysis in 2022 assessed the addition of liquid biopsy to tissue testing in advanced NSCLC and concluded it did not greatly increase healthcare costs, whilst leading to more patients receiving appropriate therapy 22 . Given the widespread adoption of liquid biopsy remains in its infancy, and the nuances of the Asia‐Pacific region in particular, the health economic impact of liquid biopsy requires further exploration 23 …”

Current and future applications of liquid biopsy in non-small-cell lung cancer—a narrative review

“…In addition to convenience, ease of access and minimal invasiveness, the major advantages of liquid biopsy include better reflection of the tumor clonal heterogeneity (spatial heterogeneity), the possibility of sequential sampling, and real-time monitoring of tumor load and its evolving mutational status (temporal heterogeneity). Supplementing the standard tissue evaluation with liquid biopsy was also shown to save system costs and increase the number of patients administered appropriate targeted therapies (13)(14)(15). Finally, a liquid biopsy may significantly shorten turnaround times at primary diagnosis and at progression (16)(17)(18).…”