Cost-Effectiveness of Single-Marker Genetic Testing vs Multigene Panel Sequencing in Advanced NSCLC
The results of an economic modeling study to estimate the cost-effectiveness of multigene panel sequencing as compared to standard-of-care single-gene tests for patients with advanced non–small cell lung cancer (NSCLC) showed that multigene panel sequencing tests are moderately cost-effective, but could deliver more value if patients with test results identifying actionable genetic mutations consistently received genetically guided treatments. These findings were published by Steuten et al in JCO Clinical Cancer Informatics.
The results of the study underline the need to align clinical practices with an era of personalized medicine in which physicians can use diagnostic tests to identify specific biologic markers that inform targeted prevention and treatment plans.
Methods
The study analyzed the clinical and economic value of using multigene panel sequencing testing to identify patients with tumors that overexpress genetic mutations that could be targeted by available therapies designed to inhibit the function of those genes. Using data provided by Flatiron Health, researchers examined clinical and cost information associated with the care of 5,688 patients with advanced NSCLC treated between 2011–2016, separating them into cohorts who received multigene panel sequencing tests that assess at least 30 genetic mutations at once and those who received single-marker genetic testing of less than 30 genes.
Results
Compared to single-marker genetic testing, the multigene panel sequencing testing strategy, including downstream treatment and monitoring of disease, incurred costs equal to $148,478 for each year of life that it facilitated. This level suggests that multigene panel sequencing is moderately cost-effective compared to commonly cited thresholds in the United States, which range from $50,000 to $200,000 per life-year gained.
The authors of the study pointed out, however, that physicians only prescribed a targeted therapy to some of the patients whose multigene panel sequencing test results revealed actionable mutations. Multigene panel sequencing tests can only improve downstream patient outcomes if actionable results are used to put the patient on a targeted treatment regimen that is more effective than the therapy they would otherwise have been prescribed. It is therefore impossible for the cost of a multigene panel sequencing test to translate into additional life-years if actionable results do not result in the selection of a targeted treatment regimen.
Although multigene panel sequencing testing revealed actionable mutations in 30.1% of the patients in the study cohort, only 21.4% of patients who underwent multigene panel sequencing testing received a targeted treatment.
The study's authors calculated that if all multigene panel sequencing–tested patients with actionable mutations had received a targeted therapy, multigene panel sequencing testing would deliver measurably better value ($110,000 per life-year gained).
The authors concluded, “On the basis of data from a nationwide oncology patient database, multigene panel sequencing is shown to have moderate cost-effectiveness compared with single-marker genetic testing in patients with advanced NSCLC.”
Disclosure: For full disclosures of the study authors, visit cci.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
