Presentation (CTI)

OBJECTIVES: The inability to detect occult synchronous lesions during surgery represents a significant challenge in identifying and managing lung cancer. Preoperative imaging often fails to identify all disease burden, and white light thoracoscopy, considered standard of care (SOC), is limited by the constraints of visual and tactile assessment. Pafolacianine-guided Intraoperative Molecular Imaging (IMI) has emerged as a possible solution to address this clinical gap. We compare the cost-effectiveness of Pafolacianine-guided IMI visualization with SOC to SOC alone, consisting of visual and tactile assessment.
METHODS: We developed a five-state lifetime Markov model to evaluate the cost-effectiveness of Pafolacianine-guided IMI with SOC compared to SOC alone. The identification of occult synchronous lesions during lung resection procedures was modeled directly from the ELUCIDATE Phase 3 trial. Health utility values, transition probabilities and health state costs (CPI adjusted) were extracted from published literature and nationally representative administrative claims databases. Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to test model robustness, with willingness-to-pay (WTP) thresholds of $50,000 per QALY.
RESULTS: The base case analysis yielded a $1,672 savings ($131,743 vs. $133,415) for Pafolacianine-guided IMI compared to SOC alone, with a corresponding 0.37 QALY gained (8.12 vs. 7.75). The incremental cost effectiveness ratio (ICER) was -$4,577/QALY, showing dominance for Pafolacianine-guided IMI. The one-way sensitivity results showed that age and occult synchronous lesion probability were most sensitive within the ICER model. Probabilistic sensitivity analysis demonstrated that Pafolacianine-guided IMI was cost-effective in 100% of iterations at $50,000/QALY.
CONCLUSIONS: Pafolacianine-guided IMI with SOC for lung cancer resections is both more effective and less expensive than traditional SOC alone. These results support further evaluation of Pafolacianine-guided IMI as a cost-effective solution for surgical lung resection procedures.