The cost and cost trajectory of whole‐genome analysis guiding treatment of patients with advanced cancers

Abstract

BackgroundLimited data exist on the real‐world costs of applying whole‐genome analysis (WGA) in a clinical setting. We estimated the costs of applying WGA to guide treatments for patients with advanced cancers and characterized how costs evolve over time.MethodsThe setting is the British Columbia Cancer Agency Personalized OncoGenomics (POG) program in British Columbia, Canada. Cost data were obtained for patients who enrolled in the program from 2012 to 2015. We estimated mean WGA costs using bootstrapping. We applied time series analysis and produced 10‐year forecasts to determine when costs are expected to reach critical thresholds.ResultsThe mean cost of WGA over the study period was CDN$34,886 per patient (95% CI: $34,051, $35,721). Over time, WGA costs decreased, driven by a reduction in costs of sequencing. Yet, costs of other components of WGA increased. Forecasting showed WGA costs may not reach critical thresholds within the next 10 years.Conclusion WGA costs decreased over the studied time horizon, but expenditures needed to realize WGA remain significant. Future research exploring costs and benefits of WGA‐guided cancer care are crucial to guide health policy.

Are whole-exome and whole-genome sequencing approaches cost-effective? A systematic review of the literature

“…3,[31][32][33][34][35][36][37][38][39][40][41][42] Seven studies presented data on the costs of WES or WGS testing pathways, [24][25][26][27][43][44][45] and eight studies presented data on clinically relevant outcome measures for these tests. 5,6,[8][9][10][46][47][48] Of the eight full economic evaluations, two were CUAs 22,23 and six were CEAs, published between 2014 and 2017 in Australia (2), the United States (1), the UK (1), the Netherlands (1), and Canada (1).…”

“…Dewey et al 43 estimated the costs of WGS in the United States as well as the costs associated with curation and clinical follow-up. Weymann et al 45 estimated the costs of using WGS to inform treatment decisions in patients with advanced cancers. Towne et al 44 estimated the cost of using WES to achieve a diagnosis in rare presentations in a pediatric population.…”

“…38 Thirteen publications stated that costs were estimated within the study; nine of these publications reported their costing approach. [19][20][21][26][27][28]36,37,45 Many publications did not state which components were included in the cost estimate. The costs for reagents ranged from £291 ($420) 35 to £1,171 ($1,685).…”

“…24 Four studies used a transparent bottom-up approach to estimate the cost of WGS. 20,21,26,28,45 There was limited evidence of a reduction in the cost of WGS over time, with the lowest estimate declining from £10,497 ($15,146) 43 in 2013 to £1,312 ($1,906) 26 in 2017. However, this is based on a small sample.…”

Methodological Issues in Assessing the Economic Value of Next-Generation Sequencing Tests: Many Challenges and Not Enough Solutions

“…We used ten known relevant articles to identify relevant search terms (16–25) (searches are described in the Appendix). The PubMed search used specific MeSH terms to identify directly relevant articles and title keywords to identify articles not yet indexed.…”