391P Economic impact of next-generation sequencing (NGS) versus single-gene testing modalities to detect genomic alterations (GAs) in metastatic non-small cell lung cancer (mNSCLC) in Asia

Loong, Herbert H. F.; Wong, Carlos K. H.; Leung, Louis M L; Chan, Catherine; Chang, Andrea; Zhou, Z-Y.; Tang, W.H. Wilson; Gibbs, Meaghan

doi:10.1016/j.annonc.2020.10.385

Cited by 1 publication

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“…Our study was in line with an investigation from Hong Kong, which showed that exclusionary testing of an EGFR mutation and ALK gene rearrangement was the best strategy in terms of reducing test-related cost and time to appropriate therapy. 27 In contrast to our results, a Singaporean study found that the per-patient cost difference of up-front NGS versus exclusionary EGFR testing was only SGD $110 (US $80). 28 Plausible explanations include a higher unit cost of EGFR testing (SGD $719 5 US $521) and a lower unit cost of tissue-based NGS testing (SGD $1,235 5 US $896) in that study compared with ours (Table 1).…”

Section: Discussioncontrasting

confidence: 99%

Economic Analysis of Exclusionary EGFR Test Versus Up-Front NGS for Lung Adenocarcinoma in High EGFR Mutation Prevalence Areas

Yang

Yeh

Chen

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: This study sought to determine whether exclusionary EGFR mutation testing followed by next-generation sequencing (NGS) is a cost-efficient and timely strategy in areas with high prevalence rates of EGFR mutation. Methods: We developed a decision tree model to compare exclusionary EGFR testing followed by NGS and up-front NGS. Patients entered the model upon diagnosis of metastatic lung adenocarcinoma. Gene alterations with FDA-approved targeted therapies included EGFR, ALK, ROS1, BRAF, RET, MET, NTRK, and KRAS. Model outcomes were testing-related costs; time-to-test results; monetary loss, taking both costs and time into consideration; and percentage of patients who could be treated by FDA-approved therapies. Stacked 1-way and 3-way sensitivity analyses were performed. Results: Exclusionary EGFR testing incurred testing-related costs of US $1,387 per patient, a savings of US $1,091 compared with the costs of up-front NGS. The time-to-test results for exclusionary EGFR testing and up-front NGS were 13.0 and 13.6 days, respectively. Exclusionary EGFR testing resulted in a savings of US $1,116 in terms of net monetary loss, without a reduction of patients identified with FDA-approved therapies. The EGFR mutation rate and NGS cost had the greatest impact on minimizing monetary loss. Given that the tissue-based NGS turnaround time was shortened to 7 days, up-front NGS testing would become the best strategy if its price could be reduced to US $568 in Taiwan. Conclusions: In areas with high prevalence rates of EGFR mutation, exclusionary EGFR testing followed by NGS, rather than up-front NGS, is currently a cost-efficient strategy for metastatic lung adenocarcinoma.

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Section: Discussioncontrasting

confidence: 99%