Could molecular pathology testing in lung cancer be more cost effective?

Aims: EGFR and ALK analysis is routinely undertaken prior to targeted treatment of non-squamous non-small cell lung carcinoma (NSCLC). Increasingly limited resources require molecular pathology services to be cost effective without detriment to patient care.
Methods: Data from an audit of molecular pathology testing in the South East of Scotland Cancer network has been used to explore different testing strategies with the aim of reducing costs; including investigation of TTF1 expression as a negative predictor for EGFR mutations.
Results: TTF1 immunohistochemistry had a high negative predictive value for EGFR mutations (99%). Reflex testing all non-squamous NSCLC had the highest costs whereas limiting testing to those who might be considered for treatment would save 7.5%; the serial model could save 32.7%.
Conclusions: Testing only patients being considered for EGFR and ALK inhibitors represented small savings; more significant savings would be achievable if testing algorithms utilized known associations between clinical biomarkers.