The treatment of choice for advanced non–small cell lung cancer is selected according to the presence of specific alterations. Patients should undergo molecular testing for relevant modifications and the mutational status of EGFR and translocation of ALK and ROS1 are commonly tested to offer the best intervention. In addition, the tests costs should also be taken in consideration. Therefore, this work was performed in order to evaluate the cost-effectiveness of a unique exam using NGS (next generation sequencing) versus other routinely used tests which involve RT-PCR and FISH. The target population was NSCLC, adenocarcinoma, and candidates to first-line therapy. Two strategies were undertaken, strategy 1 corresponded to sequential tests with EGFR RT-PCR, then FISH for ALK and ROS1. Strategy 2 differed from 1 in that ALK and ROS1 translocation testing were performed simultaneously by FISH. Strategy 3 considered single test next-generation sequencing, a platform that includes EGFR, ALK and ROS1 genes. A decision tree analysis was used to model genetic testing options. From the test results, a microsimulation model was nested to estimate survival outcomes and costs of therapeutic options. The use of NGS added 24% extra true cases as well as extra costs attributed to the molecular testing. The ICER comparing NGS with sequential tests was US$ 3479.11/correct case detected. The NGS improved a slight gain in life years and QALYs. Our results indicated that, although precise, the molecular diagnosis by NGS of patients with advanced stage NSCLC adenocarcinoma histology was not cost-effective in terms of quality-adjusted life years from the perspective of the Brazilian supplementary health system.

中文翻译：

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对晚期腺癌肺癌患者的 EGFR、ALK 和 ROS1 伴随诊断测试与下一代测序 (NGS) 进行比较的成本效益分析。

晚期非小细胞肺癌的治疗选择是根据特定改变的存在来选择的。患者应接受相关修饰的分子检测，并且通常检测 EGFR 的突变状态以及 ALK 和 ROS1 的易位，以提供最佳干预措施。此外，还应考虑测试成本。因此，开展这项工作是为了评估使用 NGS（下一代测序）的独特检查与涉及 RT-PCR 和 FISH 的其他常规使用测试的成本效益。目标人群是非小细胞肺癌、腺癌和一线治疗的候选者。采取了两种策略，策略 1 对应于 EGFR RT-PCR 的连续检测，然后针对 ALK 和 ROS1 进行 FISH。策略 2 与策略 1 的不同之处在于，ALK 和 ROS1 易位检测是通过 FISH 同时进行的。策略3考虑单次测试下一代测序，一个包含EGFR、ALK和ROS1基因的平台。决策树分析用于对基因测试选项进行建模。根据测试结果，嵌套微观模拟模型来估计生存结果和治疗方案的成本。NGS 的使用增加了 24% 的额外真实病例以及分子测试带来的额外成本。将 NGS 与序贯测试进行比较的 ICER 为 3479.11 美元/检测到正确病例。NGS 使生命年和 QALY 略有增加。我们的结果表明，尽管精确，但从巴西补充卫生系统的角度来看，晚期 NSCLC 腺癌患者的 NGS 分子诊断在质量调整生命年方面并不具有成本效益。