Early cost-effectiveness model of whole genome sequencing as a molecular diagnostic test versus standard of care in locally advanced and metastatic (Stage IIIB,C/ IV) non-squamous non-small cell lung cancer

A probabilistic cost-effectiveness model is created to simulate the molecular diagnostic pathway, treatment decision and disease progression of patients with inoperable stage IIIB,C/IV non-squamous 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. Three diagnostic strategies are modelled: A, standard of care (SoC); B, WGS as a diagnostic test; and C, SoC followed by WGS. A societal perspective is adopted. Treatment effectiveness is based on a systematic review and modelled using parametric survival models. The model calculates the incremental cost-effectiveness ratio (ICER) and net monetary benefit (iNMB). Additionally, extensive sensitivity analyses can be performed: deterministic sensitivity analyses (DSA), probabilistic sensitivity analyses (PSA), scenario sensitivity analysis (SSA) 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.