Can Next-Gen Sequencing Save Money in Lung Cancer Genetic Testing?

The upfront use of next-generation sequencing (NGS) was associated with a substantial cost savings compared with other types of genetic testing, according to a computer modeling analysis of patients with metastatic non–small-cell lung cancer (NSCLC).

“Targeted therapies have been demonstrated to significantly improve treatment response and progression-free survival,” wrote study authors led by Nathan A. Pennell, MD, PhD, of the Cleveland Clinic in Ohio. “Therefore, it is important to identify patients with specific genomic alterations to individualize treatment and optimize outcomes.”

Sequences of single-gene tests, as well as hotspot panel testing, are often used in the metastatic NSCLC setting. These can be time consuming, though, and may require a relatively large tissue sample. Only a small percentage of patients currently undergo NGS, in spite of its potential advantages.

The authors created a decision analytic model to estimate differences in testing costs and time-to-test results between NGS and other testing strategies. The results of the analysis were published in JCO: Precision Oncology.

In a hypothetical 1 million–member health plan, a total of 2,066 Medicare-insured patients and 156 commercially insured patients were estimated to be eligible for genetic testing for metastatic NSCLC. The model analyzed costs of testing, the potential need for rebiopsy, and other inputs; downstream costs including treatments were not included.

The total cost for the hypothetical Medicare-insured metastatic NSCLC patients in the analysis was $2,190,499 for NGS, compared with $3,721,368 with sequential testing; $3,584,177 with exclusionary testing; and $4,331,295 with hotspot panel testing. In the commercially insured patients, the total cost with NGS was $620,369, compared with $747,771 with sequential testing; $624,178 with exclusionary testing; and $871,211 with hotspot panel testing.

NGS and hotspot panel testing provided the shortest time-to-test results, at 2 weeks, compared with 4.7 weeks with exclusionary testing and 4.8 weeks with sequential testing. Also, NGS was able to identify all 446 of the 2,066 Medicare-insured patients and all 34 of 156 commercially insured patients who were estimated to have genetic alterations targeted by approved therapies. This was 2.3% to 5.9% more than were found using alternative testing strategies.

In this hypothetical health plan, increasing the rate of NGS testing from 25% to 50% would save $492,251 for the Centers for Medicare and Medicaid Services, and $52,421 for a commercial insurer.

“Upfront NGS testing should be used more widely to promptly inform treatment decisions for patients with metastatic NSCLC,” the authors concluded. Determining if NGS is viable in a clinical setting, however, will require cost analyses that extend beyond testing itself and into the downstream effects.

A review published in late 2017 noted that very little research has been conducted on the cost effectiveness of NGS in cancer. The authors, from the University of Sydney in Australia, noted that “in general, the cost of targeted therapy needs to be significantly reduced for the use of NGS in cancer management to become cost‐effective.” There are also questions regarding how to assess downstream cost effectiveness, including the thresholds used for the incremental cost-effectiveness ratio (ICER). “It remains an area for future research to determine whether the technology is cost‐effective in routine cancer management,” they wrote.