Economic evaluations of exome and genome sequencing in pediatric genetics: considerations towards a consensus strategy

Abstract

Objective

Next Generation Sequencing (NGS) is increasingly used for the diagnosis of rare genetic disorders. The aim of this study is to review the different approaches for economic evaluations of Next Generation Sequencing (NGS) in pediatric care used to date, to identify all costs, effects, and time horizons taken into account.

Methods

A systematic literature review was conducted to identify published economic evaluations of NGS applications in pediatric diagnostics, i.e. exome sequencing (ES) and/or genome sequencing (GS). Information regarding methodological approach, costs, effects, and time horizon was abstracted from these publications.

Results

Twenty-eight economic evaluations of ES/GS within pediatrics were identified. Costs included were mainly restricted to direct in-hospital healthcare costs and varied widely in inclusion of sort of costs and time-horizon. Nineteen studies included diagnostic yield and eight studies included cost-effectiveness as outcome measures. Studies varied greatly in terms of included sort of costs data, effects, and time horizon.

Conclusion

Large differences in inclusion of cost and effect parameters were identified between studies. Validity of outcomes can therefore be questioned, which hinders valid comparison and widespread generalization of conclusions. In addition to current health economic guidance, specific guidance for evaluations in pediatric care is therefore necessary to improve the validity of outcomes and furthermore facilitate comparable decision-making for implementing novel NGS-based diagnostic modalities in pediatric genetics and beyond.

Keywords:

• Next generation sequencing
• exome sequencing
• genome sequencing
• health technology assessment
• economic evaluations
• children
• genetics

JEL Classification Codes:

• I00
• I
• I15
• I1
• I
• O10
• O1
• O

Transparency

Declaration of funding

This work was financially supported by grants from the Netherlands Organization for Health Research and Development (ZonMw) [843002608 and 846002003 to L.E.L.M. Vissers and J.K. Ploos van Amstel]. The aims of this study also contribute to the Solve-RD project (to L.E.L.M. Vissers) which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 779257.

Declaration of financial/other interests

The authors have no conflict of interest to declare. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The results of this study contribute to the goals of the RADICON-NL consortium, which aims to increase diagnosis for patients with rare diseases in a shortened time frame, thereby reducing the complexity and overall costs associated with obtaining this diagnosis.