Cost of genetic testing, delayed care, and suboptimal treatment associated with polymerase chain reaction versus next-generation sequencing biomarker testing for genomic alterations in metastatic non-small cell lung cancer

Abstract

Aims

To assess US payers’ per-patient cost of testing associated with next-generation sequencing (NGS) versus polymerase chain reaction (PCR) biomarker testing strategies among patients with metastatic non-small cell lung cancer (mNSCLC), including costs of testing, delayed care, and suboptimal treatment initiation.

Methods

A decision tree model considered biomarker testing for genomic alterations using either NGS, sequential PCR testing, or hotspot panel PCR testing. Literature-based model inputs included time-to-test results, costs for testing/medical care, costs of delaying care, costs of immunotherapy [IO]/chemotherapy [CTX] initiation prior to receiving test results, and costs of suboptimal treatment initiation after test results (i.e. costs of first-line IO/CTX in patients with actionable mutations that were undetected by PCR that would have been identified with NGS). The proportion of patients testing positive for a targetable alteration, time to appropriate therapy initiation, and per-patient costs were estimated for NGS and PCR strategies combined.

Results

In a modeled cohort of 1,000,000 members (25% Medicare, 75% commercial), an estimated 1,119 had mNSCLC and received testing. The proportion of patients testing positive for a targetable alteration was 45.9% for NGS and 40.0% for PCR testing. Mean per-patient costs were lowest for NGS ($8,866) compared to PCR ($18,246), with lower delayed care costs of $1,301 for NGS compared to $3,228 for PCR, and lower costs of IO/CTX initiation prior to receiving test results (NGS: $2,298; PCR:$5,991). Cost savings, reaching $10,496,220 at the 1,000,000-member plan level, were driven by more rapid treatment with appropriate therapy for patients tested with NGS (2.1 weeks) compared to PCR strategies (5.2 weeks).

Limitations

Model inputs/assumptions were based on published literature or expert opinion.

Conclusions

NGS testing was associated with greater cost savings versus PCR, driven by more rapid results, shorter time to appropriate therapy initiation, and minimized use of inappropriate therapies while awaiting and after test results.

Keywords:

• Biomarker testing
• cost of testing
• delayed care
• next-generation sequencing
• non-small cell lung cancer
• polymerase chain reaction
• suboptimal treatment

JEL Classification Codes:

• I10
• I1
• I
• I18

Transparency

Declaration of funding

Financial support for this research was provided by Janssen Scientific Affairs, LLC, a Johnson & Johnson company.

Declaration of financial/other relationships

Christine M. Bestvina reports research funding to the institution from AstraZeneca and BMS, as well as personal consulting from AstraZeneca, BMS, CVS, Daiichi Sankyo, Genentech, Gilead, Jazz, JNJ, Mirati, Regeneron, Sanofi, Takeda, and Tempus. Dexter Waters, Andy He, and Julie Vanderpoel are employees of Janssen Scientific Affairs, LLC, a Johnson & Johnson company, and stockholders of Johnson & Johnson. Laura Morrison, Bruno Emond, Marie-Hélène Lafeuille, Annalise Hilts, and Patrick Lefebvre are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, a Johnson & Johnson company, which funded the development and conduct of this study and manuscript.

Author contributions

All authors were involved in the conception and design, or analysis and interpretation of the data; the drafting of the paper or revising it critically for intellectual content; and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Acknowledgements

Medical writing support was provided by a professional medical writer, Christine Tam, an employee of Analysis Group, Inc.

Data availability statement

The data underlying this article are available in the article and in its online supplementary materials.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

Part of the material in this manuscript was presented at the American Society of Clinical Oncology (ASCO) Annual Meeting held on June 2-6, 2023 in Chicago, IL, USA as a poster presentation.