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

Figures & data

Figure 1. Model diagram.

Abbreviations. 1L, first-line; NGS, next-generation sequencing; PCR, polymerase chain reaction.

Notes:

1. The estimated costs associated with delaying treatment were calculated as the time to initiation of appropriate targeted therapy times the estimated weekly cost during the pre-diagnosis phase.

2. The estimated costs associated with the initiation of treatment (i.e. immunotherapy and/or chemotherapy) prior to receiving test results were calculated as the time to initiation of appropriate targeted therapy times the weekly drug and medical costs associated with the treatment regimen.

3. Appropriate therapy was defined as targeted therapy for those with an actionable mutation or non-targeted therapy (i.e. immunotherapy and/or chemotherapy) for those without an actionable mutation. Patients who initiated immunotherapy and/or chemotherapy (i.e. non-targeted therapy) prior to receiving test results who were negative for tested alterations continued to receive non-targeted therapy.

4. Wasted expenditures associated with initiating suboptimal treatment (i.e. immunotherapy and/or chemotherapy) were calculated as the estimated incremental medical costs associated with targeted therapy as second line versus first line, times the average duration for the line of therapy.

Table 1. Clinical output summary.

	NGS	Sequential	Hotspot Panel	Both PCR Strategies Combined^1
Total number of patients tested (N)^2
Blended^3	1,119
Medicare	3,853
Commercial	207
Patients tested (%)	60.0%	10.0%	30.0%	40.0%
Patients tested positive for any mutation (%)	65.8%	52.6%	55.6%	54.8%
Patients tested positive for an actionable mutation with an approved targeted therapy^4 (%)	45.9%	37.9%	40.7%	40.0%
Patients inappropriately initiating immunotherapy/chemotherapy^5 (%)	0.0%	8.0%	5.2%	5.9%
Time to appropriate therapy initiation, per patient (weeks)^6	2.1	10.5	3.5	5.2

Abbreviations. NGS, next-generation sequencing; PCR, polymerase chain reaction.

Notes:

1. Due to rounding within the model, the total for all PCR testing strategies combined may be slightly different than the sum of each individual PCR strategy.

2. Based on a hypothetical cohort of 1,000,000 insured patients.

3. The blended population assumed that 25% of members had Medicare coverage and 75% of members had commercial coverage.

4. The following actionable mutations were considered to have approved targeted therapies: EGFR, ALK, ROS1, KRAS G12C, BRAF V600E, MET, HER2, RET, NTRK1, NTRK2, and NTRK3.

5. Calculated as the difference between the proportion of patients testing positive for an actionable mutation with NGS and the proportion of patients testing positive for an actionable mutation with a PCR testing strategy.

6. Defined as the time from the date of test collection to the date of appropriate therapy initiation.

Figure 2. Cost of genetic testing, delayed care, and suboptimal treatment, per testing strategy, among the (A) blended population,¹ (B) Medicare only population, and (C) commercial only population.

Abbreviations. 1L, first-line; NGS, next-generation sequencing; US, United States.

Notes:

1. The blended population assumed that 25% of members had Medicare coverage and 75% of members had commercial coverage.

2. Wasted expenditures associated with initiating suboptimal treatment (i.e. immunotherapy and/or chemotherapy) were calculated as the estimated incremental medical costs associated with targeted therapy as second line versus first line, times the average duration for the line of therapy.

3. The estimated costs associated with the initiation of treatment (i.e. immunotherapy and/or chemotherapy) prior to receiving test results were calculated as the time to initiation of appropriate targeted therapy times the weekly drug and medical costs associated with the treatment regimen.

4. The estimated costs associated with delaying treatment were calculated as the time to initiation of appropriate targeted therapy times the estimated weekly cost during the pre-diagnosis phase.

5. Costs include rebiopsy, outpatient/specialist visits, and PD-L1 testing costs.

Figure 3. Total budget impact for 60% versus 80% of patients tested with NGS¹.

Abbreviations. 1L, first-line; NGS, next-generation sequencing; PMPM, per member per month.

Note:

1. Includes costs of genetic testing, delayed care, pre-test treatment costs, and suboptimal 1L treatment costs.

Figure 4. Sensitivity analysis for (A) NGS and (B) both PCR testing strategies combined.

Abbreviations. NGS, next-generation sequencing; PCR, polymerase chain reaction.

Data availability statement

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