Prospective budget impact analysis of the rt-PCR test to identify EGFR gene mutations in patients with non-small cell lung cancer

Abstract

Objective: to estimate the budgetary impact of incorporating the rt-PCR test for iden-tifying EGFR mutations in patients with non-small cell lung cancer (NSCLC) into the Brazilian Unified Health System (SUS). Method: deterministic modeling was carried out, considering a 5-year time horizon (2023-2027). The eligible population was estima-ted based on the analysis of the demand of the measured population diagnosed with advanced or metastatic NSCLC and treated with chemotherapy in the SUS between 2015-2021. The data was obtained from the Outpatient Information System (SIA-SUS) database. Only the direct cost of the rt-PCR test was considered in the calculation. A technology diffusion rate was estimated in two scenarios. The uncertainties attributed to the model were tested in the sensitivity analysis, applying a variation of plus or mi-nus 25%. Results: between 2015-2021, 40,857 individuals with NSCLC were treated with chemotherapy in the SUS. The population eligible to undergo rt-PCR testing in the 2023-2027 period was estimated at 31,918 individuals. The budgetary impact of a possible adoption of the technology was R$ 23,186,140.03 in alternative scenario 1, and R$ 38,301,950.72 in alternative scenario 2. The sensitivity analysis estimated an incremental budget of R$ 17,389,605.03 for the best scenario and R$ 47,877,438.40 for the worst. Conclusion: the analysis showed that incorporating the rt-PCR test could be feasible for the health system, favoring the rational use of the tyrosine kinase inhibi-tors erlotinib and gefitinib. Keywords: Budget Impact Analysis of Therapeutic Advances; Epidermal Growth Factor Receptor Coding Genes; Lung Cancer; Unified Health System.