Cost-effectiveness analysis of molecular diagnosis by next-generation sequencing versus sequential single testing in metastatic non-small cell lung cancer patients from a south Spanish hospital perspective

ABSTRACT

Background

To assess the cost-effectiveness of using next-generation sequencing (NGS) compared to sequential single-testing (SST) for molecular diagnostic and treatment of patients with advanced non-small cell lung cancer (NSCLC) from a Spanish single-center perspective, the Hospital Universitario Virgen del Rocio (HUVR).

Research design and methods

A decision-tree model was developed to assess the alterations detection alterations and diagnostic cost in patients with advanced NSCLC, comparing NGS versus SST. Model inputs such as testing, positivity rates, or treatment allocation were obtained from the literature and the clinical practice of HUVR experts through consultation. Several sensitivity analyses were performed to test the robustness of the model.

Results

Using NGS for molecular diagnosis of a 100-patients hypothetical cohort, 30 more alterations could be detected and 3 more patients could be enrolled in clinical-trials than using SST. On the other hand, diagnostic costs were increased up to €20,072 using NGS instead of SST. Using NGS time-to-results would be reduced from 16.7 to 9 days.

Conclusions

The implementation of NGS at HUVR for the diagnostic of patients with advanced NSCLC provides significant clinical benefits compared to SST in terms of alterations detected, treatment with targeted-therapies and clinical-trial enrollment, and could be considered a cost-effective strategy.

KEYWORDS:

• Non-small cell lung cancer (NSCLC)
• molecular profiling
• oncogenic drivers
• cost-effectiveness
• next-generation sequencing
• sequential single testing

Acknowledgments

The authors would like to thank Ignacio Hernández of Hygeia Consulting for writing the first draft of the manuscript.

Declaration of interest

D Carcedo is employee of Hygeia Consulting, who received funding from Roche to conduct the analysis. N Arrabal and J Garcia are employees of Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

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

Author contributions

All authors contributed substantially to the development of the study. All the authors participated in the design of the analysis. D Carcedo developed the model and wrote the first draft of the manuscript. E de Alava, M Pareja and R Bernabe were the hospital experts who collected and validated data inputs and contributed to results interpretation. All the authors read and approved the final manuscript to be published.

Further information

Roche Farma S.A played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2022.2078310

Additional information

Funding

This work was funded by Roche Farma S.A.