Cost-Effectiveness of Next-Generation Sequencing Versus Single-Gene Testing for the Molecular Diagnosis of Patients With Metastatic Non–Small-Cell Lung Cancer From the Perspective of Spanish Reference Centers

Abstract

PURPOSE The aim of this study was to assess the cost-effectiveness of using next-generation sequencing (NGS) versus single-gene testing (SgT) for the detection of genetic molecular subtypes and oncogenic markers in patients with advanced non–small-cell lung cancer (NSCLC) in the setting of Spanish reference centers. METHODS A joint model combining decision tree with partitioned survival models was developed. A two-round consensus panel was performed to describe clinical practice of Spanish reference centers, providing data on testing rate, prevalence of alterations, turnaround times, and treatment pathways. Treatment efficacy data and utility values were obtained from the literature. Only direct costs (euros, 2022), obtained from Spanish databases, were included. A lifetime horizon was considered, so a 3% discount rate for future costs and outcomes was considered. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. RESULTS A target population of 9,734 patients with advanced NSCLC was estimated. If NGS was used instead of SgT, 1,873 more alterations would be detected and 82 more patients could potentially be enrolled in clinical trials. In the long term, using NGS would provide 1,188 additional quality-adjusted life-years (QALYs) in the target population compared with SgT. On the other hand, the incremental cost of NGS versus SgT in the target population was €21,048,580 euros for a lifetime horizon (€1,333,288 for diagnosis phase only). The obtained incremental cost-utility ratios were €25,895 per QALY gained, below the standard cost-effectiveness thresholds. CONCLUSION Using NGS in Spanish reference centers for the molecular diagnosis of patients with metastatic NSCLC would be a cost-effective strategy over SgT.

Expert-based collaborative analysis of the situation and prospects of biomarker test implementation in oncology in Spain

“…Both the Focus Group and the reviewed literature emphasize this aspect, including a previous study showing that the determination of some of the biomarkers is funded by different pharmaceutical companies in more than 50% of the hospitals [ 5 ]. Moreover, it has recently been estimated that the analysis of molecular diagnosis by NGS versus sequential single testing in metastatic non-small cell lung cancer patients from a Spanish reference centre perspective could be considered a cost-effective strategy [ 9 ]. The benefits from NGS relative to the single gene testing include the number of alterations detected, treatment with targeted therapies and clinical trial enrollment.…”

“…Regardless of how they are allocated, it must be considered that their value lies in the combination of both, so it is a joint product [ 10 ]. And as argued above, the strategy of using NGS can be cost-effective in Spain [ 9 ], but also in other countries like the US [ 12 ].…”

Evaluation of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Samples from Advanced Non-Small Cell Lung Cancer for Whole Genome, Whole Exome and Comprehensive Panel Sequencing

“…Our findings reinforce the immediate clinical value of comprehensive panel sequencing for actionable mutation detection and its applicability for most patient samples, even those with low tumor content. The adoption of comprehensive panels has been shown to have diagnostic and economic value when compared with serial single-gene testing in advanced NSCLC [2,[45][46][47]. Overall, it is previously reported that multigene panels increase the proportion of patients with access to targeted therapy when compared with combinations of single-gene tests [46], resulting in an increase in life years or quality-adjusted life years [2,47] while being cost-neutral or cost-saving to the health system [2,[45][46][47].…”

Fifteen years of precision medicine in the lung cancer management: Perspectives and Challenges

“…Although cost-effectiveness studies favored NGS testing before deciding on first-line treatment for advanced NSCLC 95,96 , costs with novel testing methodologies, turnaround time, and access restriction to some targeted therapies can still make it difficult to completely abandon older testing methods. Also, genomic testing protocols may vary geographically.…”