Comprehensive Genomic Profiling for Non-Small-Cell Lung Cancer: Health and Budget Impact

Abstract

Background Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc). However, newer testing options such as compre­hensive genomic profiling (cgp) offer improved detection rates and identification of multiple classes of genomic alterations in a single assay, minimizing tissue requirements and turnaround time. The objective of the present analysis was to assess the health and budget impacts of adopting cgp testing for nsclc in Canada.
 Methods This study assessed the impact of funding the cgp tests FoundationOne CDx and FoundationOne Liquid (Foundation Medicine, Cambridge, MA, U.S.A.) over a 3-year time horizon using a Canadian societal perspective for Ontario. Conventional testing strategies were summarized into two reference scenarios: a series of single-gene tests only, and reflex single-gene testing followed by a hotspot panel for negative results. Four adoption scenarios for cgp testing were considered: replacing all single-gene and hotspot panel testing, replacing hotspot panel testing only, use after negative single-gene and hotspot testing, and use of FoundationOne Liquid in individuals with insufficient tissue for conventional testing.
 Results When cgp testing was assumed to replace all conventional testing with 50% uptake, the budget impact per person per year ranged from $0.71 to $0.87, depending on the reference scenario, with a 3-year gain of 680.9 life–years and 3831 working days over the full cohort.
 Conclusions Given the present testing landscape for patients with nsclc in Canada, listing cgp testing could opti­mize the selection of appropriately targeted treatments, and thus add life–years and productivity for this population, with a minimal budget impact.

Health and Budget Impact of Liquid-Biopsy-Based Comprehensive Genomic Profile (CGP) Testing in Tissue-Limited Advanced Non-Small Cell Lung Cancer (aNSCLC) Patients

“…Despite the need to consider a system-wide impact, previous studies have tended to focus on studying testing or targeted therapies in a silo. A similar study by Johnston et al focused on the economic and health impact of adopting NGS and TL-LBx-CGP in NSCLC, which resulted in a lower 3-year budget (~$4.5 M) than this study [ 37 ]. The Johnston et al study focused mainly on tissue-biopsy, and made a simplifying assumption that 5% of patients had unavailable tissue for testing.…”

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

“…In the third economic study that we identified, a budget impact analysis was developed from the Canadian perspective and used a model structure similar to that used in our analysis. 66 However, because the health system is different, a direct comparison with the results of our modeling analysis cannot be made. Furthermore, the results from the Canadian budget impact analysis were not presented at the individual level; thus, any comparison of life-years gained was not feasible.…”

Targeted Treatment of Non-Small Cell Lung Cancer: Focus on Capmatinib with Companion Diagnostics

“…These studies prompted FoundationOne CDx to become a companion diagnostic for capmatinib for MET-dysregulated NSCLC. [34][35][36] Utilization of FoundationOne CDx as a companion diagnostic for other driver mutations in other solid tumors is currently being investigated, with mixed results suggesting potential applications in glioma and breast but limited utility in pancreatic ductal adenocarcinoma. [37][38][39]…”