Cost-effectiveness of alternative NTRK testing strategies in cancer patients followed by histology-independent therapy with entrectinib: an analysis of three European countries

Heleen Vellekoop, Simone Huygens, Matthijs Versteegh, László Szilberhorn, Tamás Zelei, Balázs Nagy, Rositsa Koleva-Kolarova, Sarah Wordsworth, Maureen Rutten-van Mölken, HEcoPerMed consortium

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Abstract

Aim: To explore variations in the cost-effectiveness of entrectinib across different testing strategies and settings. Methods: Four testing strategies where adult cancer patients received entrectinib if they tested positive for NTRK gene fusions compared with 'no testing' and standard of care (SoC) for all patients were evaluated. Results: Immunohistochemistry for all patients followed by RNA-based next-generation sequencing after a positive result was the optimal strategy in all included countries. However, the incremental net monetary benefit compared with SoC was negative in all countries, ranging between international euros (int€) -206 and -404. In a subgroup analysis with only NTRK-positive patients, the incremental net monetary benefit was int€ 8405 in England, int€ -53,088 in Hungary and int€ 54,372 in The Netherlands. Conclusion: Using the cost-effectiveness thresholds recommended by national guidelines, none of the testing strategies were cost-effective compared with no testing. The implementation of entrectinib is unlikely to become cost-effective in Hungary, due to the large cost difference between the entrectinib and SoC arms, while there might be more potential in England and The Netherlands.

Original languageEnglish
Pages (from-to)321-338
Number of pages18
JournalPersonalized Medicine
Volume20
Issue number4
DOIs
Publication statusPublished - 1 Jul 2023

Bibliographical note

Financial & competing interests disclosure
The HEcoPerMed project has received funding from the European Union’s Horizon 2020 research and innovation program under
grant agreement No. 824997. The authors have no other relevant affiliations or financial involvement with any organization or
entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from
those disclosed.
No writing assistance was utilized in the production of this manuscript.

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