The economic impact of using NGS vs. single-gene testing strategies in patients (pts) with mNSCLC have substantial implications on healthcare resource allocation. Pennell et al. (JCO PO 2019) have shown the use of upfront NGS testing in pts with mNSCLC was associated with substantial cost savings and shorter time-to-test results in the United States. Such conclusions may not necessarily apply in other jurisdictions where the prevalence of pts with actionable mutations, cost of healthcare and reimbursement models differ. Taking Hong Kong (HK) as an example, we assess the economic impact of NGS vs. single-gene testing in Asia.
A decision analytical model was built to compare sequential (SE), panel (PA), exclusionary (EX), and upfront NGS testing in pts with newly diagnosed mNSCLC. In SE and PA, pts were tested for GAs with approved treatment (EGFR, ALK, ROS1, BRAF) followed by SE or NGS for other GAs. In EX, EGFR and ALK were tested first, followed by NGS. 2.4 % of pts were assumed to receive re-biopsy and 25% to continue testing for non-actionable GAs. For each modality, mutation identified, time to receive testing results, and costs (2019 USD) were estimated. Sensitivity analyses (SAs) was used to test model robustness.
For Hong Kong (∼7.3M population), EX required the shortest time to receive results (1.5 weeks) and was most cost-saving compared to other modalities. If all pts use EX, $3.0M cost saving will be achieved compared with current practice, with 96.1% of actionable and 46.5% of non-actionable GA being detected. If all pts use NGS, it will cost an additional $4.5M to payer with a 100% GA detection rate. The results were sensitive to NGS price and the % of pts continued testing for non-actionable GAs.
As opposed to findings by Pennell et al., EX rather than upfront NGS is the best option in terms of cost and time to results in HK. This is also applicable for other Asia countries as this is driven by higher prevalence of mNSCLC pts with EGFR mutations in the Asian population. EX, however, does not capture all possible GAs. As more GA become actionable and NGS testing costs reduce, NGS may potentially be a cost saving option.
Novartis Corporation.
Has not received any funding.
H. Loong: Advisory/Consultancy, Speaker Bureau/Expert testimony: Boehringer-Ingelheim; Advisory/Consultancy: Celgene; Advisory/Consultancy: Eli-Lilly; Advisory/Consultancy, Speaker Bureau/Expert testimony: Ignyta; Advisory/Consultancy: Loxo Oncology; Advisory/Consultancy, No honorarium or specific COI to this specific study: Novartis; Advisory/Consultancy: Merck; Advisory/Consultancy: Takeda; Advisory/Consultancy, Research grant/Funding (institution): MSD; Research grant/Funding (institution): Mundipharma; Speaker Bureau/Expert testimony: Abbvie; Speaker Bureau/Expert testimony: Eisai; Speaker Bureau/Expert testimony: Guardant Health. C.P.K. Chan, A. Chang, M. Gibbs: Full/Part-time employment: Novartis. All other authors have declared no conflicts of interest.