Molecular Testing in Primary Advanced or Recurrent Endometrial Cancer: A Cost-Effectiveness Analysis.

Abstract

Purpose: We assessed the cost-effectiveness of Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) testing versus no molecular testing to guide initial treatment in stage III/IV primary advanced or recurrent endometrial cancer (pA/rEC) from payer and societal perspectives.

Methods: A decision tree for molecular classification followed by a partitioned survival model estimated lifetime costs and outcomes for ProMisE versus no testing. Patients in the no testing arm received carboplatin + paclitaxel (CP), dostarlimab + CP, pembrolizumab + CP, or hormonal therapy (everolimus + letrozole). Patients in the ProMisE arm received the same treatments or bevacizumab + CP. Survival functions were derived from trial results. EQ-5D-5L utility values were from the RUBY trial (ClinicalTrials.gov identifier: NCT03981796). Costs were sourced from US databases and literature. The base case presented a US third-party payer perspective. A scenario analysis presented a modified societal perspective. Outcomes were total life-years (LYs), total quality-adjusted LYs (QALYs), total costs, and incremental cost-effectiveness ratio (ICER) of ProMisE versus no testing.

Results: From a payer perspective, total LYs and total QALYs were 5.36 and 4.08 with ProMisE versus 3.83 and 2.89 with no testing, respectively. Total costs were $233,989 US dollars (USD) with ProMisE versus $155,305 USD with no testing. Incremental LYs and QALYs were 1.53 and 1.19 greater with ProMisE; incremental costs over a lifetime were $78,684 USD greater with ProMisE. Assuming a threshold of $150,000 USD per QALY gained, ProMisE was cost effective with an ICER of $66,321 USD per QALY gained. From a societal perspective, lifetime costs were lower (-$22,973 USD) and QALYs greater with ProMisE versus no testing.

Conclusion: ProMisE testing is cost effective compared with no testing. Given the heterogeneity of molecular subtypes in stage III/IV pA/rEC, molecular testing enables personalized treatment that is both clinically meaningful and of high value from payer and societal perspectives.