Cost-effectiveness of an autoantibody test (AABT) as an aid to diagnosis of lung cancer.

7030 Background: An AABT to aid in lung cancer diagnosis has been recently developed. While less sensitive than computed tomography (CT), it can detect smaller and less-advanced cancers and has greater specificity. The cost-effectiveness of AABT in this use is unknown. Methods: We developed a model depicting the consequences of screening—a single time —a hypothetical cohort of 100,000 high-risk screening-naive patients for lung cancer using CT followed by AABT if positive (CT->AABT) versus CT alone and no screening (with CT or AABT). Non-small cell lung cancer (NSCLC)—indolent and aggressive types—and small cell lung cancer (SCLC) were considered. Sensitivity and specificity of AABT (price=$300) were assumed to be 40% and 90% (data on file, Oncimmune Inc.); for CT (price=$301), were calculated to be 47% and 49% from a “prevalence screen” perspective using data from the Mayo Clinic screening study. Cancers detected with CT->AABT were assumed, on average, to be smaller and less advanced due to more aggressive work-up of patients positive on both tests. Cost-effectiveness was calculated as the ratio of the difference in expected costs (2008 USD) to the difference in life-years (LY) (and quality-adjusted life- years [QALYs]) for CT->AABT versus CT alone and no screening. Results: A total of 2,901 of the 100,000 high-risk persons would be expected to have undiagnosed aggressive NSCLC or SCLC. Of the 2,901 cases, 1,363 (true positives) would be detected with CT->AABT or CT alone and would gain 6.3 and 5.7 LYs, respectively, versus no screening; false positives would total 49,079. Cost per LY gained with CT->AABT vs no screening was $20,044, and versus CT alone, $19,293. Estimates of cost per QALY gained were similar. Conclusions: Screening high-risk patients for lung cancer using AABT as an aid to CT based on the above assumptions is likely to be cost-effective by current standards in comparison with screening with CT alone or no screening. Model outcomes (discounted) No screening CT CT- >AABT LY 1,505,557 1,509,526 1,510,392 QALY 1,303,4 17 1,305,991 1,306,651 Costs $230,946,859 $311,161,933 $327,875,140 Screening $0 $30,051,000 $43,780,230 Diagnostic $10,480,549 $51,227,441 $55,250,510 Treatment $220,466,310 $229,88 3,492 $228,844,400 Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Oncimmune Oncimmune Oncimmune Ethicon Endosurgery, Inc., Synovis, Inc. Oncimmune, Policy Analysis Inc. Oncimmune