Budget Impact Analysis of Comprehensive Genomic Profiling in Patients With Advanced Non–Small-Cell Lung Cancer

Abstract

PURPOSE This study assessed the economic impact of increased use of comprehensive genomic profiling (CGP) versus conventional testing strategies among patients with advanced non–small-cell lung cancer (aNSCLC) from a US commercial health plan perspective. METHODS A decision analytic model was developed to estimate the incremental benefits and costs across testing methodologies (CGP v non-CGP), as well as across sample types (tissue-based and liquid-based), for patients with newly diagnosed aNSCLC. Model outcomes included total direct costs, testing costs, and per member per month budget impact. Secondary model outcomes included the number of patients needed to test with CGP to add 1 life-year, and the number of patients needed to test with CGP to treat one individual with a biomarker-matched therapy. RESULTS In a hypothetical 2,000,000-member health plan, 790 members were estimated to have incident aNSCLC; 609 underwent molecular diagnostic testing with 122 (20%) tested with CGP (109 tissue-based and 13 liquid) in the base-case. An increase in CGP from 20% to 30% (an additional 61 patients tested with CGP) was associated with 3.11 additional life-years gained and a $0.01 in US dollars per member per month budget impact. Approximately 19.6 patients would need to be tested with CGP versus non-CGP to add one life-year and 5.9 patients would need to be tested with CGP to treat at least one patient with a biomarker-matched therapy. CONCLUSION An increase in CGP from 20% to 30% among patients with aNSCLC undergoing molecular diagnostic testing was associated with modest budget impact, most of which was attributable to prolonged survival associated with increased use of more effective treatments.

Comprehensive Review on the Clinical Impact of Next-Generation Sequencing Tests for the Management of Advanced Cancer

“…b Refs. 38 , 39 , 62 - 65 . NGS, next-generation sequencing; OS, overall survival; PFS, progression-free survival.…”

Impact on costs and outcomes of multi-gene panel testing for advanced solid malignancies: a cost-consequence analysis using linked administrative data

“…Prior studies have evaluated the cost of NGS panel testing by the use of budget impact models including multiple assumptions that may limit the external applicability of the results to real-world contexts. 22 For example, some prior studies have included the assumption that patients have wide access to all the potential matched therapies available or lack real-world efficacy outcomes and instead use survival times obtained on clinical trial reported data. 22 The use of estimates based on clinical trial data may overestimate the benefit provided by NGS panel testing.…”

“… 22 For example, some prior studies have included the assumption that patients have wide access to all the potential matched therapies available or lack real-world efficacy outcomes and instead use survival times obtained on clinical trial reported data. 22 The use of estimates based on clinical trial data may overestimate the benefit provided by NGS panel testing.…”

A global analysis of the value of precision medicine in oncology – The case of non-small cell lung cancer

“…The model also included other monthly medical service costs reflecting outpatient visits, interventions, and unplanned hospitalizations unrelated to AEs from a previous publication for the United States ( 19 ). These costs were converted to local costs in the remaining countries using differences in PPP.…”