OBJECTIVES:

to perform a cost-utility analysis of a screening strategy with a liquid biopsy to detect early lung cancer detection of an asymptomatic high-risk population from the Brazilian Public Healthcare perspective.

METHODS:

A decision-analytic model combined with a Markov was constructed using the Microsoft Excel® (2019) software. A decision tree captured the number of lung cancer detected in advanced and early stages, based on the immunological biomarker test (EarlyCDT Lung).

The Markov modelled the long-term outcomes from lung cancer throughout lifetime.

Direct costs were collected from the Brazilian health data system of medical procedures corresponding to 2019 Brazilian currency and were converted to U.S. dollars (US$) at the rate of 4,03 Brazilian reais/1 US$ (12/31/2019) and 5% discount rate was used. The other parameters like the sensitivity and specificity of the diagnostic test, transitions probabilities and utilities to each health state were derived from existing literature.

RESULTS:

In a hypothetical cohort of 1,000 individuals, an ICER of U$ 98,647.89 /QALY was obtained and deterministic analyses showed the variables with greatest impact on the results. The prevalence of lung cancer, the sensitivity of the liquid biopsy, the annual discount rate and the mortality after diagnosis in the initial condition in 5 years. Considering the impact of these variations, the model proved to be robust against an ICER range of U$ 54,011.28 to U$ 182,075.69/QALY. In all simulated scenarios from probabilistic sensitivity analysis the ICER were concentrated above of U$ 8,592.22/QALY, equivalent to 1 Brazilian gross domestic product (GDP) per capita/QALY in 2019.

CONCLUSIONS:

All results were concentrated above Brazilian GDP per capita, indicating that this strategy was not cost-effective in Brazil. The screening with liquid biopsy would only become cost effective if the Brazilian lung cancer prevalence context was greater than 15%.