Cost-effectiveness of precision medicine in the fourth-line treatment of metastatic lung adenocarcinoma: an early decision analytic model of multiplex targeted sequencing

Highlights • Increasingly once all treatment strategies are exhausted or on development of resistance to targeted therapies it is not uncommon to consider further multiplex targeted sequencing to select targeted therapies as fourth-line treatment in lung adenocarcinoma. • Despite the prospect of improved treatment options, the use of multiplex targeted sequencing panels is associated with additional costs and uncertainty as to their impact on overall outcomes. • The point estimate incremental cost-effectiveness ratios reported in the base case analysis for multiplex targeted sequencing were very unfavourable (AUD 485,199/LY and AUD 489,338/QALY), but a number of parameters were identified to have large impacts on the incremental cost-effectiveness ratios. • The most impactful model parameters related to multiplex targeted sequencing were mortality rates during testing and for true positive patients at one year as well as the number of hospitalizations for true positive patients. Other parameters related to testing and the cost of off-label targeted therapy, however, had relatively small impacts on the incremental cost-effectiveness ratios. • Reducing uncertainty in cost and resource use parameters associated with multiplex targeted sequencing, testing parameters and clinical transition probabilities for multiplex targeted sequencing were shown to have the largest value, indicating that additional research may be a worthwhile investment. • Plausible future scenario analyses highlighted the limited impact that improvements in technology and/or scientific understanding will have on the cost-effectiveness of multiplex targeted sequencing.