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PPM4 COST-EFFECTIVENESS ANALYSIS OF NEXT GENERATION SEQUENCING PANEL OF CIRCULATING TUMOR DNA IN THE DIAGNOSIS OF PATIENT WITH METASTATIC NON-SQUAMOUS NON- SMALL CELL LUNG CANCER IN BRAZIL

      Objectives

      The aim of this study was to evaluate the cost-effectiveness analysis of NGS panel of ctDNA versus ctDNA EGFR testing in patients with metastatic non-squamous non-small cell lung who lack tissue material for evaluation of oncogenic mutation.

      Methods

      A decision model and Markov model was developed in order to estimate the results of diagnostic tests and therefore its clinical and economic impact in the first line treatment. The horizon time was 1 year and the perspective was the private payer perspective in Brazil. The analysis included the target therapies of EGFR, ALK, ROS-1 and BRAF; and the combined therapy of pembrolizumab plus chemotherapy. The first line of treatment was chosen according to the test results and the NCCN guideline. The analysis was conducted in three scenarios that differ in relation to the target therapies incorporated: (1) EGFR and ALK; (2) EGFR, ALK and ROS-1; (3) EGFR, ALK, ROS-1 and BRAF. Clinical outcomes were derived from clinical trials of the therapies included in the study. The direct medical costs were based on CBHPM (Classificação Brasileira Hierarquizada de Procedimentos Médicos) and CMED PF 18% (Câmara de Regulação do Mercado de Medicamentos). The cost of NGS panel of ctDNA assumed in the analysis was 5,000 BRL. The study did not consider the cost of ctDNA EGFR testing because pharmaceutical companies are bearing the cost of the test.

      Results

      In the three scenarios evaluated, the NGS panel of ctDNA has the potential to save respectively: -4,138.67 BRL; -6,245.10 BRL and -5,720.48 BRL in one year. The ICER were: -15.595,77 (BRL/PFS); -21.399,29 (BRL/PFS); -18.006,42 (BRL/PFS).

      Conclusions

      The savings generated with NGS panel of ctDNA are resulted of the lower use of immunotherapy in the first line. In all scenarios the NGS panel demonstrated to be a dominant alternative in comparison to ctDNA EGFR testing.