Next-Generation Sequencing in Clinical Practice: Is It a Cost-Saving Alternative to a Single-Gene Testing Approach?

Abstract

Objectives This study aimed to compare the costs of a next-generation sequencing-based (NGS-based) panel testing strategy to those of a single-gene testing-based (SGT-based) strategy, considering different scenarios of clinical practice evolution. Methods Three Italian hospitals were analysed, and four different testing pathways (paths 1, 2, 3, and 4) were identified: two for advanced non-small-cell lung cancer (aNSCLC) patients and two for unresectable metastatic colon-rectal cancer (mCRC) patients. For each path, we explored four scenarios considering the current clinical practice and its expected evolution. The 16 testing cases (4 scenarios × 4 paths) were then compared in terms of differential costs between the NGS-based and SGT-based approaches considering personnel, consumables, equipment, and overhead costs. Break-even and sensitivity analyses were performed. Data gathering, aimed at identifying the hospital setup, was performed through a semi-structured questionnaire administered to the professionals involved in testing activities. Results The NGS-based strategy was found to be a cost-saving alternative to the SGT-based strategy in 15 of the 16 testing cases. The break-even threshold, the minimum number of patients required to make the NGS-based approach less costly than the SGT-based approach, varied across the testing cases depending on molecular alterations tested, techniques adopted, and specific costs. The analysis found the NGS-based approach to be less costly than the SGT-based approach in nine of the 16 testing cases at any volume of tests performed; in six cases, the NGS-based approach was found to be less costly above a threshold (and in one case, it was found to be always more expensive). Savings obtained using an NGS-based approach ranged from €30 to €1249 per patient; in the unique testing case where NGS was more costly, the additional cost per patient was €25. Conclusions An NGS-based approach may be less costly than an SGT-based approach; also, generated savings increase with the number of patients and different molecular alterations tested.

Targeting RNA with Next‐ and Third‐Generation Sequencing Improves Pathogen Identification in Clinical Samples

“…Moreover, sequencing‐based approaches are a promising approach for the diagnosis of infectious disease because a comprehensive spectrum of potential causes—viral, bacterial, fungal, and parasitic—can be identified by a single assay, even when new, emerging pathogens are concerned such as SARS‐CoV‐2. [ 30 , 31 , 32 ] Being relatively cheap and straightforward, mNGS (mainly using Illumina platforms) is the major sequencing‐based pathogen detection, and mtNGS developed in our study (added reverse transcription) only incurs very limited extra cost. In comparison, TGS platforms such as ONT and Pacbio are still in their early developing stage and relatively costly, especially considering the reduced sequencing outcome.…”

Identifying the Steps Required to Effectively Implement Next-Generation Sequencing in Oncology at a National Level in Europe

“…In this context, the importance of NGS-driven, high-tech screening and diagnostics have been given new prominence by the exigencies of the COVID-19 pandemic; the continually rising burden of cancer in Europe [57] has also lent new significance to technologies that can deliver more selective and effective treatments, with benefits for health budgets as well as for patients. For example, in advanced non-small cell lung cancer, NGS has been shown to have a modest budget impact for payers, with the potential to better enable selection for targeted therapy and clinical trial enrollment [58][59][60][61].…”

Next Generation Sequencing Technology in Lung Cancer Diagnosis

“…In addition, recent studies have shown that by implementing NGS-based testing, clinics can reduce the cost required for evaluating biomarkers specifically for targeted treatments or agnostic therapy implementation. NGS-based testing can reduce total testing cost by EUR 30–1249 depending on how comprehensive the analysis is, when compared to RT-PCR technology [ 80 ].…”