Cost-Effectiveness and Budget Impact Model of Future Developments With Whole-Genome Sequencing for Lung Cancer Patients

A probabilistic cost-effectiveness and budget impact model are created to simulate the molecular diagnostic pathway, treatment decision and disease progression of patients with inoperable stage IIIB,C/IV non-squamous non-small-cell lung cancer (NSCLC), from a Dutch healthcare perspective. A decision tree represents the diagnostic process and treatment selection, and a cohort state transition model (STM) the disease progression. The STM has four health states: no progression, progression first line (of treatment administration), progression second line, and death. Transitions of patients between the health states are modelled using one-month cycle lengths over a lifetime time horizon. Two diagnostic strategies are modelled: standard of care (SoC), and WGS as a diagnostic test (base-model). A societal perspective is adopted. Additionally, three scenarios that are deemed likely by experts to take place within five years were modelled. These scenarios concerned: WGS results used for treatment selection (scenario 1); WGS based biomarker for immunotherapy (scenario 2); and off-label drug approval for WGS results (scenario 3). Outcomes were reported for the base-model, all scenarios separately, combined (combined-unweighted), and weighted by likelihood (combined-weighted). Treatment effectiveness is based on a systematic review and modelled using parametric survival models. The model calculates the incremental costs, effects, cost-effectiveness ratio (ICER), and net monetary benefit (iNMB). Additionally, extensive sensitivity analyses can be performed: deterministic sensitivity analyses (DSA), probabilistic sensitivity analyses (PSA), and scenario sensitivity analysis (SSA). The model is also capable of performing budget impact analysis and threshold analysis. The default willingness to pay (WTP) threshold is set at €80,000 per quality adjusted life year (QALY), as advised for this patient population in the Netherlands.