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. 2023 Mar:7:e2200546.
doi: 10.1200/PO.22.00546.

Cost-Effectiveness of Next-Generation Sequencing Versus Single-Gene Testing for the Molecular Diagnosis of Patients With Metastatic Non-Small-Cell Lung Cancer From the Perspective of Spanish Reference Centers

Edurne Arriola  1 , Reyes Bernabé  2 , Rosario García Campelo  3 , Michele Biscuola  2 , Ana Belén Enguita  4 , Fernando López-Ríos  4 , Rafael Martínez  5 , Laura Mezquita  6 , Sarai Palanca  7   8 , María Jesús Pareja  2 , Jon Zugazagoitia  4   9   10   11 , Natalia Arrabal  12 , J Francisco García  12 , David Carcedo  13 , Enrique de Álava  2   14
Affiliations

Cost-Effectiveness of Next-Generation Sequencing Versus Single-Gene Testing for the Molecular Diagnosis of Patients With Metastatic Non-Small-Cell Lung Cancer From the Perspective of Spanish Reference Centers

Edurne Arriola et al. JCO Precis Oncol. 2023 Mar.

Abstract

Purpose: The aim of this study was to assess the cost-effectiveness of using next-generation sequencing (NGS) versus single-gene testing (SgT) for the detection of genetic molecular subtypes and oncogenic markers in patients with advanced non-small-cell lung cancer (NSCLC) in the setting of Spanish reference centers.

Methods: A joint model combining decision tree with partitioned survival models was developed. A two-round consensus panel was performed to describe clinical practice of Spanish reference centers, providing data on testing rate, prevalence of alterations, turnaround times, and treatment pathways. Treatment efficacy data and utility values were obtained from the literature. Only direct costs (euros, 2022), obtained from Spanish databases, were included. A lifetime horizon was considered, so a 3% discount rate for future costs and outcomes was considered. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainty.

Results: A target population of 9,734 patients with advanced NSCLC was estimated. If NGS was used instead of SgT, 1,873 more alterations would be detected and 82 more patients could potentially be enrolled in clinical trials. In the long term, using NGS would provide 1,188 additional quality-adjusted life-years (QALYs) in the target population compared with SgT. On the other hand, the incremental cost of NGS versus SgT in the target population was €21,048,580 euros for a lifetime horizon (€1,333,288 for diagnosis phase only). The obtained incremental cost-utility ratios were €25,895 per QALY gained, below the standard cost-effectiveness thresholds.

Conclusion: Using NGS in Spanish reference centers for the molecular diagnosis of patients with metastatic NSCLC would be a cost-effective strategy over SgT.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/po/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Figures

FIG 1.
FIG 1.
Diagram of the model. ALK, anaplastic lymphoma receptor kinase gene; BRAF, B-Raf proto-oncogene, serine/threonine kinase; EGFR, epidermal growth factor receptor gene; HER2, human epidermal growth factor receptor 2 gene; KRAS, KRAS proto-oncogene; MET, MET proto-oncogene; NTRK, Neurotrophic tyrosine receptor kinase gene; PSM, partitioned survival models; RET, RET proto-oncogene; ROS1, ROS proto-oncogene 1, receptor tyrosine kinase; WT, wild-type.
FIG 2.
FIG 2.
Short-term results: alterations detected in the target population. ALK, anaplastic lymphoma receptor kinase gene; BRAF, B-Raf proto-oncogene, serine/threonine kinase; EGFR, epidermal growth factor receptor gene; HER2, human epidermal growth factor receptor 2 gene; KRAS, KRAS proto-oncogene; MET, MET proto-oncogene; NGS, next-generation sequencing; NTRK, neurotrophic tyrosine receptor kinase gene; RET, RET proto-oncogene; ROS1, ROS proto-oncogene 1, receptor tyrosine kinase; SgT, single-gene testing; WT, wild-type.
FIG 3.
FIG 3.
One-way sensitivity analysis, represented by tornado diagrams. ICUR, incremental cost-utility ratio; NGS, next-generation sequencing; PD, progressed disease; PFS, progression-free survival.
FIG 4.
FIG 4.
PSA results, represented by a cost-effectiveness plane. PSA, probabilistic sensitivity analysis; QALYs, quality-adjusted life-years.
See this image and copyright information in PMC

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