Comprehensive genomic profiling in advanced/metastatic colorectal cancer: number needed to test and budget impact of expanded first line use

Figures & data

Figure 1. Model conceptual structure.

Figure 2. Model decision tree.

Table 1. Genomic alteration and testing inputs by molecular diagnostic testing type (base case inputs).

Locus	Prevalence (%)^3^,^28–30^,a	Tempus (%)		Non-CGP (%)		Other CGP (%)
		Testing rate^31	Sensitivity^32	Testing rate^17^,b	Sensitivity^33^,^34	Testing rate^c	Sensitivity^c
KRAS	52.6	100	98	100	95	100	98
NRAS	3.8	100	98	79	95	100	98
BRAF (V600E)	6.4	100	98	84	96	100	98
dMMR/MSI	4.0	100	100	86	100	100	100
NTRK fusion	0.1	100	97	10	90	100	97
HER2 (ERBB2 RTK amplification)	2.6	100	92	10	90	100	92
MET (RTK amplification)	0.6	100	92	10	90	100	92
RET	0.2	100	97	10	90	100	97
PIK3CA mutation	3.4	100	98	10	90	100	98
EGFR	0.1	100	98	10	90	100	98
POLE1 mutation	5.0	100	98	10	90	100	98

^a KRAS, NRAS and POLE1 alteration rates were based on 100% of the patient population, while other rates accounted for overlap between alterations: BRAF alteration rates were exclusive of RAS positive patients, and all other alteration rates were exclusive of RAS and RAF positive patients.

^b NTRK, HER2, MET, RET, PIK3CA, and EGFR alteration testing rates and testing sensitivity for non-CGP are assumptions.

^c Other CGP testing rate and sensitivity assumed to be equal to Tempus testing.

Abbreviations. CGP, comprehensive genomic profiling; dMMR, deficient mismatch repair; MSI, microsatellite instability.

Table 2. Results–missed opportunities under usual testing (calculated).

Missed opportunities for genomically informed 1L care in mCRC (compendium-listed or clinical trials) over two years in a plan with 5M covered lives
Total missed opportunities to put patients on matched therapy or clinical trial^a (n)	521
Missed opportunities due to lack of testing^b (n)	442
Missed opportunities due to non-CGP testing^b (n)	79
NNT with Tempus to give 1 additional opportunity for biomarker matched therapy or matched clinical trial (n)	7.8

^a The missed opportunities to put patients on matched therapy or clinical trials was calculated based on a hypothetical 100% initial testing rate in first-line advanced/metastatic colorectal cancer patients.

^b The missed opportunities due to lack of testing or non-CGP testing were both calculated based on the current initial testing rate in first-line advanced/metastatic colorectal cancer patients.

Abbreviations. 1L, first-line; 5M, five million; CGP, comprehensive genomic profiling; NNT, number needed to test.

Table 3. Results – impacts on costs and opportunities for matched care.

Impact of increasing CGP (with Tempus) from 0 to 20% of 1L mCRC patients, per year, in a plan with 5M covered lives
Increase in matched therapy or matched clinical trial opportunities (n)	15.5
Incremental budget impact, PMPM ($)^a	0.003
Total budget impact, per year ($)^a	202,102
Cost to put 1 additional patient on matched therapy or matched clinical trial ($)	13,005
Incremental budget impact, per diagnosed mCRC patient per year ($)^a	182

^a All costs are reported in nominal 2020 USD.

Abbreviations. 1L, first-line; 5M, five million; CGP, comprehensive genomic profiling; mCRC, advanced/metastatic colorectal cancer; PMPM, per member per month.

Figure 3. Budget impact results, segmented by year and by source of cost.

Figure 4. Budget impact results, by category (year 2), PMPM, in US Cents. Abbreviations. NNT, number needed to test; PMPM, per member per month.

Figure 5. Budget impact sensitivity analysis (year 2), $PMPM. Abbreviations. 1L, first-line; mCRC, advanced/metastatic colorectal cancer; PMPM, per member per month.

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