COST-EFFECTIVENESS OF ION AS A BIOPSY TOOL FOR PATIENTS CURRENTLY INELIGIBLE FOR BIOPSY IN THE LUNG CANCER DIAGNOSTIC PATHWAY
Author(s)
Luc Curtis-Gretton, MEng1, Angel Varghese, MSc1, Hayden Holmes, PGDipPH, BCom1, Harriet Fewster, MSc1, James Lavin, MSc2, Ritu Finnerty, MSc3, Rachele Busca, MBA, MSc, PharmD2, Frank O'Neill, PhD4.
1York Health Economics Consortium, York, United Kingdom, 2Intuitive Surgical, Aubonne, Switzerland, 3Intuitive Surgical, Bedminster, NJ, USA, 4Intuitive Surgical, Dublin, Ireland.
1York Health Economics Consortium, York, United Kingdom, 2Intuitive Surgical, Aubonne, Switzerland, 3Intuitive Surgical, Bedminster, NJ, USA, 4Intuitive Surgical, Dublin, Ireland.
OBJECTIVES: Robotic-assisted bronchoscopy (RAB) may increase biopsy eligibility, reduce diagnostic delay, and reduce procedure-related adverse events. This study evaluated the cost-effectiveness of Ion compared with no biopsy in patients initially ineligible for existing biopsy techniques.
METHODS: A de novo patient-level simulation (PLS) model was developed in R Shiny from the UK National Health Service (NHS) and Personal Social Services (PSS) perspective using 2025 costs. Individual patient and nodule characteristics were simulated. Individuals progressed through risk stratification, diagnostic testing, watch-and-wait surveillance, cancer diagnosis, and treatment. The intervention arm assumed patients received an initial biopsy using Ion. Across two distinct comparators, patients did not receive an initial biopsy but could become eligible for CT-guided biopsy or electromagnetic navigation bronchoscopy (ENB) if sufficient nodule growth was observed during surveillance. The model structure and assumptions were informed by a care pathway analysis involving UK clinicians. The impact of Ion was primarily captured through increased biopsy eligibility, reduced diagnostic delay, and subsequent reductions in cancer progression. Outcomes included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).
RESULTS: Ion was dominant compared with no initial biopsy, generating cost savings of £479 and £411 per person when compared with pathways in which CT-guided biopsy or ENB were subsequently available. In both analyses, Ion was associated with QALY gains of 0.38 per person. Cost savings were primarily driven by reductions in watch-and-wait surveillance, fewer unnecessary tumor resections, and earlier cancer diagnosis. Results were most sensitive to assumptions regarding watch-and-wait referral patterns, diagnostic yield, and diagnostic test sensitivity.
CONCLUSIONS: Ion was associated with improved outcomes and reduced costs in populations initially ineligible for comparator biopsy techniques. PLS modelling informed by care pathway analysis enabled important pathway-specific benefits to be captured.
METHODS: A de novo patient-level simulation (PLS) model was developed in R Shiny from the UK National Health Service (NHS) and Personal Social Services (PSS) perspective using 2025 costs. Individual patient and nodule characteristics were simulated. Individuals progressed through risk stratification, diagnostic testing, watch-and-wait surveillance, cancer diagnosis, and treatment. The intervention arm assumed patients received an initial biopsy using Ion. Across two distinct comparators, patients did not receive an initial biopsy but could become eligible for CT-guided biopsy or electromagnetic navigation bronchoscopy (ENB) if sufficient nodule growth was observed during surveillance. The model structure and assumptions were informed by a care pathway analysis involving UK clinicians. The impact of Ion was primarily captured through increased biopsy eligibility, reduced diagnostic delay, and subsequent reductions in cancer progression. Outcomes included costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).
RESULTS: Ion was dominant compared with no initial biopsy, generating cost savings of £479 and £411 per person when compared with pathways in which CT-guided biopsy or ENB were subsequently available. In both analyses, Ion was associated with QALY gains of 0.38 per person. Cost savings were primarily driven by reductions in watch-and-wait surveillance, fewer unnecessary tumor resections, and earlier cancer diagnosis. Results were most sensitive to assumptions regarding watch-and-wait referral patterns, diagnostic yield, and diagnostic test sensitivity.
CONCLUSIONS: Ion was associated with improved outcomes and reduced costs in populations initially ineligible for comparator biopsy techniques. PLS modelling informed by care pathway analysis enabled important pathway-specific benefits to be captured.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE381
Topic
Economic Evaluation, Medical Technologies
Disease
Oncology, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)