Value of next generation sequencing (NGS) testing in advanced cancer patients

Abstract

Objective

The availability of targeted therapies for oncology patients is increasing. Available genomic tests to identify treatment-eligible patients include single gene tests and gene panel tests, including the whole-exome, whole-transcriptome OncoExTra test. We assessed the costs and clinical benefits of test choice.

Methods

A Microsoft Excel-based model was developed to evaluate test choice in patients with advanced/metastatic non-small cell lung cancer (NSCLC), breast, prostate, and colorectal cancer. Treatment pathways were based on NCCN guidelines and medical expert opinion. Inputs were derived from published literature. Annual economic results and lifetime clinical results with OncoExTra testing were projected per-tested-patient and compared with single gene testing and no testing. Separately, results were estimated for a US health plan without the OncoExTra test and with its use in 5% of patients.

Results

Compared with no genomic testing, OncoExTra test use increased costs by $4,915 per patient; however, 82%–92% of individuals across tumour types were identified as eligible for targeted therapy or a clinical trial. Compared with single gene testing, OncoExTra test use decreased costs by $9,966 per-patient-tested while increasing use of approved or investigational targeted therapies by 20%. When considering a hypothetical health plan with 1 million members, 858 patients were eligible for genomic testing. Using the OncoExTra test in 5% of those eligible, per-member per-month costs decreased by $0.003, ranging from cost-savings of $0.026 in NSCLC patients to a $0.009 increase in prostate cancer patients. Cost-savings were driven by reduced treatment costs with increased clinical trial enrolment and reduced direct and indirect medical costs associated with targeted treatments.

Limitations

Limitations include the required simplifications in modelling complex conditions that may not fully reflect evolving real-world testing and treatment patterns.

Conclusions

Compared to single-gene testing, results indicate that using next generation sequencing test such as OncoExTra identified more actionable alterations, leading to improved outcomes and reduced costs.

Keywords:

• Oncology
• genomic testing
• diagnostics
• costs
• comparative effectiveness

JEL CLASSIFICATION CODES:

• I18
• I1
• I
• C50
• C5
• C

Transparency

Declaration of financial/other relationships

All authors completed ICMJE forms. The authors declare the following potential conflicts of interest: JDO is a former employee PHAR, which was paid by Exact Sciences Corporation to conduct the research described in the manuscript. GCC is an employee and shareholder of Exact Sciences Corporation. KB is a former employee PHAR, which was paid by Exact Sciences Corporation to conduct the research described in the manuscript. DWH reports support for attending meetings and/or travel from Exact Sciences Corporation; owns stock or stock bonds in Exact Sciences Corporation. YA reports grants or contracts from: AACR/Robert WINN diversity in clinical trials CDA, MetaVivor; consulting fees: Exact Sciences Corporation; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: MJH Holdings, WebMD, CCO; support for attending meetings and/or travel: CARISMA therapeutics; participation on a Data Safety Monitoring Board or Advisory Board: AstraZeneca.

A reviewer of this manuscript has disclosed that they have received consulting fees from Exact Sciences. The other reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

The Editor’s in Chief helped with adjudicating the final decision on this paper.

Author contributions

All authors have met ICMJE authorship criteria. All authors agree to be accountable for all aspects of the work.

Acknowledgements

None stated.

Previous presentations

Portions of these analyses were presented at 2023 ISPOR International Conference.

Additional information

Funding

This work was supported by Exact Sciences Corporation.