Author of

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  P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 26828

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    P2.01-32 - Economic Evaluation of Diagnostic Platforms for T790M Detection in Post EGFR-TKI NSCLC in Brazil (ID 14328)

    16:45 - 18:00  |  Author(s): Rosangela Caetano
    • Abstract
    • Slides

    Background
    

    50% of acquired resistance to first or second-generation EGFR-TKIs NSCLC treatment is attributed to T790M mutation. Clinical trials demonstrated superior efficacy of osimertinib versus chemotherapy in second line setting. Nevertheless, the required molecular testing to identify T790M mutation is a challenge considering difficulties related to tissue re-biopsies. Nowadays, availability of noninvasive ctDNA techniques permits safer and faster molecular diagnostic. In Brazil, there are some commercially available tests presenting different accuracy rates. Our objective was to compare current T790M ctDNA tests cost-effectiveness, under local perspective.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    The population is NSCLC post first-line EGFR-TKI progression. Decision tree model started with cfDNA evaluation (RT-PCR based kit, Digital Droplet PCR, or NGS). Due to ctDNA methods intermediate sensitivity, tumor sample analysis is recommended if plasma result is negative. Strategies were a combination of cfDNA tests and RT-PCR based kit or NGS for tumors re-biopsies. Prevalence of T790M mutation, test accuracy, proportion of unknown or unfeasible samples were used to calculate each branch. Tissue re-biopsies complications and costs were also considered. The model was analyzed from a healthcare-payer perspective based on Brazilian private sector.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Plasma ddPCR then tissue biopsy NGS (if plasma negative) was the most effective, with cost-effective ratio of US$ 3,855.43 per positive T790M detected. Its cost was higher than the second most effective strategy (plasma-NGS + tissue NGS). Incremental cost-effectiveness ratio between both was US$ 21,193.66 per additional positive case detected. All strategies using RT-PCR based kit for plasma and/or tissue were dominated.

    

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    In terms of costs and effectiveness, the best algorithms to detect more T790M positive cases are combination of ctDNA (ddPCR or NGS) and NGS test for tumor re-biopsy. ddPCR use followed by NGS permits identification of 5% more T790M mutations than the dominated methods. This study is an effort to optimize expenditures and integrate diagnostics discussions in Brazilian health system.

    6f8b794f3246b0c1e1780bb4d4d5dc53

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