domingo, 21 de mayo de 2017

Cost-Effectiveness of a Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer. - PubMed - NCBI

2017 May 9. pii: S1556-0864(17)30364-7. doi: 10.1016/j.jtho.2017.04.030. [Epub ahead of print]

Cost-Effectiveness of a Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer.

Feller-Kopman D1, Liu S2, Geisler BP3, DeCamp MM4, Pietzsch JB5.

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Abstract

BACKGROUND:

The use of a bronchial genomic classifier has been shown to improve the diagnostic accuracy of bronchoscopy for suspected lung cancer by identifying patients who may be more suitable for radiographic surveillance as opposed to undergoing invasive procedures. Our objective was to assess the cost-effectiveness of bronchoscopy plus genomic classifier versus bronchoscopy alone in the diagnostic work-up of patients at intermediate risk for lung cancer.

METHODS:

A decision-analytic Markov model was developed to project the costs and effects of two competing strategies, using test performance from the AEGIS-1 and AEGIS-2 studies. Diagnostic accuracy of non-invasive and invasive follow-up, as well as associated adverse event rates were derived from published literature. Procedure costs were based on claims data and 2016 inpatient and outpatient reimbursement amounts. The model projected the number of invasive follow-up procedures, two-year costs and quality-adjusted life years, by strategy, and the resulting incremental cost-effectiveness ratio (ICER), discounted at 3% per annum.

RESULTS:

Use of the genomic classifier reduced invasive procedures by 28% at one month and 18% at two years, respectively. Total costs and QALY gain were similar with classifier use ($27,221 vs. $27,183, and 1.512 vs. 1.509, respectively), resulting in an ICER of $15,052 per QALY.

CONCLUSIONS:

Our analysis suggests that the use of a genomic classifier is associated with meaningful reductions in invasive procedures at about equal costs and is therefore a high-value strategy in the diagnostic work-up of patients at intermediate risk of lung cancer.