INTROCUTION: The use of Comprehensive Genomic Profiling (CGP) and target therapies are associated with substantial improvements in clinical outcomes among patients with Non-Small Cell Lung Cancer (NSCLC). However, the costs of CGP may increase the financial pressures of NSCLC on health systems worldwide, especially in low- and middle-income countries. This study aims to estimate the cost-effectiveness of CGP compared to current genomic tests in patients with NSCLC from the perspective of the Colombian Health System.

METHODS: To estimate the costs and benefits of CGP and its comparators: (1) immunohistochemistry (IH) and Real-time Polymerase Chain Reaction (RT-PCR) and (2) Fluorescence in Situ Hybridization (FISH), we developed a two-stage cohort model with a lifetime horizon. In the first stage, we made up a decision tree that calculated the probability of receiving each therapy (approved by the National Institute of Drug and Food Monitoring in Colombia) as a result of identifying a specific, actionable target. In the second stage, we developed a partitioned survival model that estimated the time spent at each health state. Only direct costs were included. Incremental cost-effectiveness ratios (ICERs) were calculated for Life-Years (LY) and Quality-Adjusted Life Years (QALYs) gained. All costs were expressed in 2019 international dollars (INT$).

RESULTS: The use of CGP is associated with additional gains of 0.06 LYs and 0.04 QALYs compared to current genomic tests. ICERs for CGP ranged from INT$ 861 to INT$ 7,848, depending on the outcome and the comparator. Sensitivity analyses show that the cost-effectiveness decision was sensitive to prices of CGP above INT$ 7,170 per test. These results are robust to most deterministic and probabilistic sensitivity analyses.

CONCLUSIONS: CGP is highly cost-effective in patients with NSCLC from the perspective of the Colombian Health System (societal willingness-to-pay threshold of INT$ 15,630 to INT$ 46,890).