Next-generation sequencing in NSCLC and melanoma patients: a cost and budget impact analysis

Abstract

Next-generation sequencing (NGS) has reached the molecular diagnostic laboratories. Although the NGS technology aims to improve the effectiveness of therapies by selecting the most promising therapy, concerns are that NGS testing is expensive and that the 'benefits' are not yet in relation to these costs. In this study, we give an estimation of the costs and an institutional and national budget impact of various types of NGS tests in non-small-cell lung cancer (NSCLC) and melanoma patients within The Netherlands. First, an activity-based costing (ABC) analysis has been conducted on the costs of two examples of NGS panels (small- and medium-targeted gene panel (TGP)) based on data of The Netherlands Cancer Institute (NKI). Second, we performed a budget impact analysis (BIA) to estimate the current (2015) and future (2020) budget impact of NGS on molecular diagnostics for NSCLC and melanoma patients in The Netherlands. Literature, expert opinions, and a data set of patients within the NKI (n = 172) have been included in the BIA. Based on our analysis, we expect that the NGS test cost concerns will be limited. In the current situation, NGS can indeed result in higher diagnostic test costs, which is mainly related to required additional tests besides the small TGP. However, in the future, we expect that the use of whole-genome sequencing (WGS) will increase, for which it is expected that additional tests can be (partly) avoided. Although the current clinical benefits are expected to be limited, the research potentials of NGS are already an important advantage.

Keywords: NSCLC; Next-generation sequencing; budget impact; melanoma; personalised medicine; targeted therapy; test costs.

Figure 1.. Budget impact analysis model, showing the aspects within the ISPOR framework for the old, current, and future environment. The arrows indicate a change of one of the aspects overtime. The target populations are divided into patients receiving peripheral and specialized care, based on the type of hospital they are diagnosed. At the bottom, the average cost differences per patient and population between the old and current environment and current and future environment are shown for both NSCLC and melanoma patients. NSCLC = non-small-cell lung cancer, NGS = next-generation sequencing, WGS = whole-genome sequencing.

Figure 2.. Estimated costs per sample, dependent on the number of samples per run, assuming one run per week, and complete runs. The costs are shown for both the small- and medium TGP on the Illumina Miseq^TM or Hiseq^TM. There is a maximum of four samples for the medium TGP on the Illumina Miseq^TM, therefore only one data point is given. NGS = next-generation sequencing, TGP = targeted gene panel.

Figure 3.. One-way sensitivity analysis on the effect of four parameters on the test costs in the current situation of NSCLC patients in specialised hospitals. TGP = targeted gene panel.

Figure 4a and b.. One-way sensitivity analysis on the effect of three parameters on the budget impact of the future scenario. The amounts on the x-as are shown in millions and account for the Dutch NSCLC patient population (4a) and the Dutch melanoma patient population (4b). NSCLC = non-small-cell lung cancer, NGS = next-generation sequencing, WGS = whole-genome sequencing.