Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA

Table 1. Base-case cost-effectiveness analysis

	Total values		Incremental values^b		ICER ($/QALY)	NHB^c (QALY)
Surveillance strategy^a	Cost ($)	Effectiveness (QALY)	Costs ($)	Effectiveness (QALY)	ICER ($/QALY)	NHB^c (QALY)
Stage I
Routine clinical physical examination	5664	13.223	—	—	—	13.166
cfEBV DNA-guided MRI + CT + BS	6902	13.233	1239	0.010	119,368	13.164
cfEBV DNA-guided PET/CT	8113	13.236	1210	0.002	518,871	13.155
Routine MRI + CT + BS	11,546	13.237	3433	0.001	3,882,176	13.121
Routine PET/CT	17,458	13.241	5913	0.004	1378,484	13.066
Stage II
Routine clinical physical examination	6694	12.121	—	—	—	12.054
cfEBV DNA-guided MRI + CT + BS	8341	12.150	1647	0.029	57,308	12.066
cfEBV DNA-guided PET/CT	9719	12.158	1378	0.009	162,041	12.061
Routine MRI + CT + BS	13,098	12.160	3379	0.002	1,923,004	12.029
Routine PET/CT	19,470	12.174	6373	0.014	454,793	11.979
Stage III
Routine clinical physical examination	8421	11.452	—	—	—	11.367
cfEBV DNA-guided MRI + CT + BS	10,562	11.497	2141	0.046	46,860	11.392
cfEBV DNA-guided PET/CT	12,259	11.513	1697	0.016	108,549	11.390
Routine MRI + CT + BS	16,149	11.514	3891	0.001	2,780,611	11.353
Routine PET/CT	23,765	11.538	7615	0.024	318,452	11.300
Stage IV
Routine clinical physical examination	10,101	9.869	—	—	—	9.768
cfEBV DNA-guided MRI + CT + BS	12,845	9.947	2744	0.079	34,906	9.819
cfEBV DNA-guided PET/CT	14,788	9.978	1944	0.031	62,269	9.831
Routine MRI + CT + BS	18,363	9.978	3574	-0.001	Dominated^d	9.794
Routine PET/CT	26,342	10.022	11,553	0.044	262,724	9.759

Abbreviations: BS, bone scintigraphy; cfEBV, cell-free Epstein-Barr virus; CT, computed tomography; ICER, incremental cost-effectiveness ratio; MRI, magnetic resonance imaging; NHB, net health benefit; PET/CT, positron emission tomography/computed tomography; QALY, quality-adjusted life-year
^a Routine clinical physical examination consists of history and physical examinations, complete blood counts, comprehensive metabolic panels and nasopharyngoscopies. Other strategies also include routine clinical physical examination. Please see the manuscript for the full description of each strategy
^b Incremental values were compared with the previous less costly and nondominated strategy
^c Calculated at the willingness-to-pay threshold of $100,000 using the following formula: effectiveness − cost/willingness-to-pay. Strategies with the highest NHB values, highlighted in bold, are considered the most cost-effective
^d Refer to a strategy that is less effective and more costly than another strategy

ISSN: 1741-7015