Genomic Profiling for NSCLC Improves Survival Outcomes With Modest Budget Impact

An increase in the use of comprehensive genomic profiling among patients with advanced non–small cell lung cancer (NSCLC) was associated with additional life-years gained and a low-cost budget impact.

Increasing use of comprehensive genomic profiling (CGP) may lead to improved survival outcomes among patients with advanced non–small cell lung cancer (aNSCLC), with a minimal budgetary impact, according to the results of a study published in JCO Precision Oncology.

Lung cancer is the leading cause of cancer-related mortality among US men and women and has been associated with projected costs of $18.8 billion in 2020 that is projected to double by 2040. With NSCLC representing 84% of all lung cancers, of which 79% of patients present with advanced disease, researchers noted that many of the actionable oncogenic drivers previously identified for the condition could be leveraged in as many as 50% to 69% of patients.

“Identifying these genomic alterations is crucial for making optimal treatment decisions because the growing number of effective therapies that target driver oncogenes is continuously changing the paradigm for aNSCLC treatment,” said researchers. “Target-specific therapies have the ability to significantly improve response to treatment and progression-free survival compared with therapeutic regimens that do not target a specific alteration.”

Although National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology recommend broad molecular profiling in eligible patients with metastatic NSCLC, researchers noted that questions remain about the costs and benefits of precision medicine, and the implications of using CGP vs other testing strategies.

They developed a decision analytic model to estimate the incremental benefits and costs across testing methodologies (CGP vs non-CGP), as well as across sample types (tissue-based and liquid-based), for patients with newly diagnosed aNSCLC.

The primary outcomes assessed included total direct costs, testing costs, and per member per month budget impact, with secondary model outcomes addressing the number of patients needed to test with CGP to add one life-year and the number of patients needed to test with CGP to treat one individual with a biomarker-matched therapy.

In the hypothetical 2,000,000-member health plan, 790 members were indicated to have incident aNSCLC in year 1, in which 609 were estimated to undergo molecular diagnostic testing (545 tissue-based and 64 liquid-based). Findings of the base-case analysis estimated 122 patients to undergo CGP (109 tissue-based and 13 liquid-based), with per patient drug costs projected to be $237,403 and the total cost of care estimated to be $325,548.

When increasing CGP use from 20% to 30% (an additional 61 patients tested with CGP), the patient cohort was associated with 3.11 additional life-years gained, with 3.02 attributed to tissue-based testing and 0.1 to liquid-based testing. Moreover, the per member per month budget impact of increasing CGP use was estimated to be $0.01 US dollars.

Regarding secondary outcomes, findings indicated that approximately 19.6 patients would need to be tested with CGP vs non-CGP to add one life-year and 5.9 patients would need to be tested with CGP to treat at least one patient with a biomarker-matched therapy.

“The increase in CGP was associated with clinical benefit and a relatively small increase in overall costs, suggesting that CGP can help lead to an overall improvement in the quality of care for patients with aNSCLC,” concluded the study authors.

Reference

Harvey MJ, Cunningham R, Sawchyn B, et al. Budget impact analysis of comprehensive genomic profiling in patients with advanced non–small-cell lung cancer. JCO Precis Oncol. Published online October 14, 2021. doi:10.1200/PO.20.00540