WCLC 2025 - Posters & ePosters-P1.17.25 Cost-Effectiveness of Initial Pan-TRK IHC Followed by RNA-NGS for NTRK Fusion Detection in Patients With NSCLC in China

P1.17.25 Cost-Effectiveness of Initial Pan-TRK IHC Followed by RNA-NGS for NTRK Fusion Detection in Patients With NSCLC in China

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This study evaluates the cost-effectiveness of a two-step diagnostic approach—initial pan-TRK immunohistochemistry (IHC) screening followed by RNA next-generation sequencing (NGS) confirmation—for detecting NTRK gene fusions in patients with advanced/metastatic non-small cell lung cancer (NSCLC) in China. NTRK fusions, present in about 0.24% of NSCLC cases, are actionable targets for therapy, making accurate and efficient detection critical.<br /><br />Using a decision tree model reflecting the Chinese healthcare system, the authors compared the pan-TRK IHC plus RNA-NGS strategy against direct NGS testing in two scenarios: one with 40% driver-gene-negative patients and another with patients lacking driver gene testing. Model inputs—including diagnostic accuracy, clinical efficacy, costs, and turnaround times—were drawn from literature, expert interviews, and public databases.<br /><br />Results demonstrated that the pan-TRK IHC screening followed by RNA-NGS confirmation was dominant in both scenarios, yielding higher progression-free life years (PFLYs) and quality-adjusted life years (QALYs) at substantially lower costs compared to direct NGS. For example, among 10,000 driver-gene-negative patients, this approach provided 3.21 incremental PFLYs and saved over 17 million Chinese Yuan. Additionally, the combined method reduced average diagnostic wait times by 11 days. When extrapolated to the large population of around 633,000 NSCLC patients in China, the strategy was projected to save over one billion CNY and provide significant gains in life-years and quality of life.<br /><br />Sensitivity analyses confirmed the robustness of these findings. Overall, this study supports the implementation of a cost-efficient two-step NTRK testing algorithm—initial pan-TRK IHC screening followed by RNA-NGS confirmation—in Chinese NSCLC patients to optimize clinical outcomes and healthcare resource use.

Asset Subtitle

Yuchen Han

Meta Tag

Speaker Yuchen Han

Topic Global Health, Health Services, and Health Economics

Keywords

NTRK gene fusions

non-small cell lung cancer

NSCLC

pan-TRK immunohistochemistry

RNA next-generation sequencing

cost-effectiveness

China healthcare system

diagnostic accuracy

progression-free life years

quality-adjusted life years