Alan B. Sandler, MD, Corey J. Langer, MD, Mark A. Socinski, MD, and David Gandara, MD, discuss the cost-effectiveness of molecular testing and targeted therapies for patients with advanced non-small cell lung cancer.

Sandler begins the conversation by noting that targeted therapies, as well as molecular testing, is cost effective because of the dramatic benefit to quality of life and overall survival. Langer adds that patients with mutations who receive targeted therapies are now living 2 to 3 years, which was not the case before these therapies were used.

Socinski asserts that some discrepancy in the cost-effectiveness between the mutant population and wild-type population for EGFR TKIs may exist, since their use is not restricted only to patients with a mutation. On the other hand, patients only receive the agent crizotinib if they test positive for the ALK translocation, which only occurs in 2-4% of patients. This excludes patients who will not benefit from treatment and is a very cost-effective approach.

As an example, Gandara notes that he explains to both patients and practitioners that molecular testing costs $3,000 to $4,000, while a month of erlotinib costs double that, and a month of bevacizumab costs four times that amount. Identifying a patient upfront who will benefit from treatment or not rather than administering empiric erlotinib is cost-effective, since many patients will not contrive a benefit. Overall, information in the form of molecular testing empowers the patient and is cost-effective in the long run.

This segment concludes the Non-Small Cell Lung Cancer: Advances and Issues Peer Exchange discussion.