UCSF

Objective

To perform a distributional cost-effectiveness analysis of liquid biopsy (LB) followed by, if needed, tissue biopsy (TB) (LB-first strategy) relative to a TB-only strategy to inform first-line treatment of advanced non-small-cell lung cancer (aNSCLC) from a US-payer perspective by which we quantify the impact of LB-first on population health inequality according to race and ethnicity.

Methods

With a health economic model, quality-adjusted life years (QALYs) and costs per patient were estimated for each subgroup. Given the lifetime risk of aNSCLC, and assuming equally-distributed opportunity costs, the incremental net health benefits of LB-first were calculated, which were used to estimate general population quality adjusted life expectancy at birth (QALE) by race and ethnicity with and without LB-first. The degree of QALYs and QALE differences with the strategies was expressed with inequality indices. Their differences were defined as the inequality impact of LB-first.

Results

LB-first resulted in an additional 0.17 (95%uncertainty interval 0.06;0.32) QALYs among treated patients, with the greatest gain observed among Asian patients (0.26 QALYs (0.08;0.52)). LB-first resulted in an increase in relative inequality in QALYs among patients, but a minor decrease in relative inequality in QALE.

Conclusion

LB-first to inform first-line aNSCLC therapy can improve health outcomes but with current diagnostic performance, the benefit is the greatest among Asian patients thereby potentially widening racial and ethnic differences in survival among aNSCLC patients. Assuming equally-distributed opportunity costs and access, LB-first does not worsen and, in fact, may reduce inequality in general population health according to race and ethnicity.