Cost-effectiveness of KRAS, EGFR and ALK testing for decision making in advanced nonsmall cell lung carcinoma: the French IFCT-PREDICT.amm study

ALK rearrangement and EGFR/KRAS mutations constitute the primary biomarkers tested to provide targeted or nontargeted therapies in advanced nonsmall cell lung cancer (NSCLC) patients. Our objective was to assess the cost-effectiveness of biomarker testing for NSCLC. Between 2013 and 2014, 843 treatment-naive patients were prospectively recruited at 19 French hospitals into a longitudinal observational cohort study. Two testing strategies were compared, i.e. with ``at least one biomarker status known'' and ``at least KRAS status known'', in addition to ``no biomarker testing'' as the reference strategy. The Kaplan-Meier approach was employed to assess restricted mean survival time. Direct medical costs incurred by hospitals were estimated with regard to treatment, inpatient care and biomarker testing. Compared with ``no biomarker testing'', the ``at least one biomarker status known'' strategy yielded an incremental cost-effectiveness ratio of EUR13230 per life-year saved, which decreased to EUR7444 per life-year saved with the ``at least KRAS status known'' testing strategy. In sensitivity analyses, biomarker testing strategies were less costly and more effective in 41% of iterations. In summary, molecular testing prior to treatment initiation proves to be cost-effective in advanced NSCLC management and may assist decision makers in defining conditions for further implementation of these innovations in general practice.