在晚期和复发性非鳞状非小细胞肺癌中使用下一代测序和单基因测试的Oncomine™ Dx Target Test MultiCDx系统的成本效益分析

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL
JMA journal Pub Date : 2024-07-16 Epub Date: 2024-07-10 DOI:10.31662/jmaj.2023-0206
Tomomi Kohara, Shunya Ikeda, Koichi Benjamin Ishikawa
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引用次数: 0

摘要

简介为了确定晚期/复发性非鳞状非小细胞肺癌(NSCLC)患者的适当治疗方法,开展了一项辅助诊断,通过基因测试检测驱动基因突变。在日本,使用可全面检测基因突变的下一代测序(NGS)或单基因检测的 Oncomine Dx Target Test (DxTT) 被用作辅助诊断。此外,还进行了成本效益分析,以比较日本使用 NGS 的 Oncomine DxTT 与单基因检测的成本效益:方法:目标人群包括晚期/复发性非鳞癌 NSCLC 患者。参考先前的研究和日本《2022 年肺癌临床实践指南》,构建了 Oncomine DxTT 策略和三种单基因检测(即表皮生长因子受体 (EGFR) 突变和无性淋巴瘤激酶 (ALK)/c-ros 致癌基因 1 (ROS1) 重排)的模型结构。模型结构假定将进行基因检测,并根据驱动基因突变情况使用《2022 年日本肺癌临床实践指南》中最推荐的药物进行一线治疗。模型输入来自日本的文献和价目表,并进行了成本效用分析:对于Oncomine DxTT策略,预计增量成本和有效性分别约为172,361日元(策略A和策略B分别为12,285,228日元和12,112,867日元)和每名患者-0.51质量调整生命年(策略A和策略B分别为21.93质量调整生命年和22.44质量调整生命年)。因此,成本增加了,但有效性却降低了。因此,Oncomine DxTT 策略在三种单基因检测中占主导地位。敏感性和情景分析表明,Oncomine DxTT 的检测成功率会影响结果:结论:对于晚期/复发性非鳞状 NSCLC 患者来说,在一线治疗前使用 Oncomine DxTT 进行基因检测与三种单基因检测(表皮生长因子受体/ALK/ROS1)相比并不划算。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-effectiveness Analysis of the Oncomine™ Dx Target Test MultiCDx System Using Next-generation Sequencing and Single-gene Test in Advanced and Recurrent Nonsquamous Non-small-cell Lung Cancer.

Introduction: To determine the appropriate treatment for patients with advanced/recurrent nonsquamous non‒small-cell lung cancer (NSCLC), a companion diagnostic was conducted to detect driver mutations through genetic testing. In Japan, Oncomine Dx Target Test (DxTT) using next-generation sequencing (NGS) that can comprehensively detect gene mutations or single-gene tests are conducted as companion diagnostics. Furthermore, cost-effectiveness analysis was conducted to compare the cost-effectiveness of Oncomine DxTT using NGS with that of single-gene test in Japan.

Methods: The target population included patients with advanced/recurrent nonsquamous NSCLC. A model structure was constructed for the Oncomine DxTT strategy and three single-gene tests (i.e., epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1) rearrangements) with reference to previous studies and the Clinical Practice Guidelines of Lung Cancer 2022 in Japan. The model structure assumed that genetic testing would be conducted and first-line treatment used the drug most recommended in the 2022 Japanese Lung Cancer Clinical Practice Guidelines, depending on the driver mutation,. Model inputs were obtained from the literature and price list in Japan, and cost-utility analysis was conducted.

Results: For the Oncomine DxTT strategy, the expected incremental costs and effectiveness were estimated to be approximately JPY 172,361 (JPY 12,285,228 vs. JPY 12,112,867 for strategies A and B, respectively) and -0.51 quality-adjusted life-year (QALY) per patient (21.93 QALY vs. 22.44 QALY for strategies A and B). As a result, the costs increased but the effectiveness decreased. Therefore, the Oncomine DxTT strategy was dominated by the three single-gene tests. Sensitivity and scenario analyses revealed that the test success rate of Oncomine DxTT affected the results.

Conclusions: The genetic test using Oncomine DxTT before the first-line treatment is not cost-effective compared with the three single-gene tests (EGFR/ALK/ROS1) for patients with advanced/recurrent nonsquamous NSCLC.

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