Cost-Effectiveness of Early Liquid Biopsy in Patients With Suspicious Metastatic Lung Cancer Alongside the LIBELULE Randomized Phase III Trial
Author(s)
Lionel Perrier, PhD1, Pierre Avenas, Ing1, Magali Morelle, MSc1, Hubert Curcio, MD2, Gabriel Le Moel, MD3, Didier Debieuvre, MD4, Jean-Marc Dot, MD5, Michaël Duruisseaux, MD6, Luc Odier, MD7, Acya Bizieux-Thaminy, MD8, Annie Peytier, MD9, Roland Schott, MD10, Stéphane Hominal, MD11, Nitzan Rosenfeld, FMedSci, PhD12, Pierre Saintigny, MD1, Maurice Pérol, MD1, Aurélie Swalduz, MD1.
1Cancer Centre Leon Berard, Lyon, France, 2Centre François Baclesse, Caen, France, 3Centre Hospitalier du Cotentin Louis Pasteur, Cherbourg, France, 4Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Mulhouse, France, 5Medipole, Villeurbanne, France, 6Hospices Civils de Lyon Cancer Institute, Lyon, France, 7Hôpital Nord-Ouest Villefranche sur Saône, Villefranche-sur-Saone, France, 8CH Départemental Vendée, La Roche-sur-Yon, France, 9Centre Hospitalier de Bayeux, Bayeux, France, 10Institut de Cancérologie Strasbourg Europe, Strasbourg, France, 11Centre Hospitalier Annecy-Genevois, Epagny-Metz Tessy, France, 12Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.
1Cancer Centre Leon Berard, Lyon, France, 2Centre François Baclesse, Caen, France, 3Centre Hospitalier du Cotentin Louis Pasteur, Cherbourg, France, 4Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Mulhouse, France, 5Medipole, Villeurbanne, France, 6Hospices Civils de Lyon Cancer Institute, Lyon, France, 7Hôpital Nord-Ouest Villefranche sur Saône, Villefranche-sur-Saone, France, 8CH Départemental Vendée, La Roche-sur-Yon, France, 9Centre Hospitalier de Bayeux, Bayeux, France, 10Institut de Cancérologie Strasbourg Europe, Strasbourg, France, 11Centre Hospitalier Annecy-Genevois, Epagny-Metz Tessy, France, 12Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.
OBJECTIVES: Genomic profiling is a major component for first-line treatment decisions in patients with non-small cell lung cancer (NSCLC) and the timeliness of biomarker testing is essential to improve time to treatment initiation or avoid inappropriate treatment. The aim of this study was to conduct a cost-effectiveness analysis (CEA) based on patient-level data from the LIBELULE (LIquid Biopsy for the Early detection of LUng cancer Lesion) multicenter, randomized, comparative, open-label phase III study showing with early ctDNA a non-significant improvement in time to treatment initiation.
METHODS: Patients with radiological suspicion of advanced lung cancer were randomized (1:1), the control arm receiving diagnostic procedures according to each center's practice and the liquid biopsy arm with additional ctDNA performed at the first visit using the InVisionFirst®-Lung assay1. Hospital costs (€2023) were assessed from the French National Health perspective with a 12-month time horizon. Local Hospital Discharge (PMSI) database were used. Incremental cost-effectiveness ratio (ICER) in cost per progression free life year gained (PF-LYG) was calculated. Uncertainty around ICERs was captured by bootstrap.
RESULTS: Among the 309 randomized patients, 298 (151 for the liquid biopsy arm and 147 for control) were available for economic analysis. Total mean costs per patient were €26,225 (SD: 30,621) in the liquid biopsy group and €24,362 (SD: 31,309) in the control group. Mean progression free survival were 0.555 (SD: 0.383) and 0.495 (SD: 0.397) year respectively, leading to an ICER of €31,112 per PF-LYG. The probability of the ICER belonging to each quadrant of the cost-effectiveness plane was the highest for the North-East quadrant (65.2%), where the liquid biopsy arm was both costlier and more effective than the control arm.
CONCLUSIONS: These results indicated that liquid biopsy is deemed to be more effective, albeit at a higher cost, compared to the control for PFS.1Swalduz et al. J Thorac Oncol 2025.
METHODS: Patients with radiological suspicion of advanced lung cancer were randomized (1:1), the control arm receiving diagnostic procedures according to each center's practice and the liquid biopsy arm with additional ctDNA performed at the first visit using the InVisionFirst®-Lung assay1. Hospital costs (€2023) were assessed from the French National Health perspective with a 12-month time horizon. Local Hospital Discharge (PMSI) database were used. Incremental cost-effectiveness ratio (ICER) in cost per progression free life year gained (PF-LYG) was calculated. Uncertainty around ICERs was captured by bootstrap.
RESULTS: Among the 309 randomized patients, 298 (151 for the liquid biopsy arm and 147 for control) were available for economic analysis. Total mean costs per patient were €26,225 (SD: 30,621) in the liquid biopsy group and €24,362 (SD: 31,309) in the control group. Mean progression free survival were 0.555 (SD: 0.383) and 0.495 (SD: 0.397) year respectively, leading to an ICER of €31,112 per PF-LYG. The probability of the ICER belonging to each quadrant of the cost-effectiveness plane was the highest for the North-East quadrant (65.2%), where the liquid biopsy arm was both costlier and more effective than the control arm.
CONCLUSIONS: These results indicated that liquid biopsy is deemed to be more effective, albeit at a higher cost, compared to the control for PFS.1Swalduz et al. J Thorac Oncol 2025.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE246
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Oncology, Personalized & Precision Medicine