Switch to NGS Would Lead to More Targeted NSCLC Care, but May Not Lower Costs

The study, based on care in Japan, found patients would be more quickly referred for targeted therapy.

Adopting next-generation sequencing (NGS) instead of sequential single-gene (SSG) testing would likely lead to a slight increase in the future costs of diagnosing and treating patients with advanced non-small cell lung cancer (NSCLC), but the switch would also enable faster initiation of therapy and more targeted treatments, according to a new study out of Japan.

Lung cancer represents the most common cause of cancer-related morbidity and mortality among people in Japan, noted corresponding author Toru Ogawa, MD, of Bayer Yakuhin, Ltd., and colleagues. In cases of NSCLC, identifying genetic mutations can allow doctors to leverage targeted therapies that improve outcomes.

There are currently 2 methods to identify such mutations—NGS and SSG. SSG involves testing for single mutations in order of prevalence, but it is more time-consuming and often requires multiple biopsies, the authors noted. NGS is newer, requires smaller tissue samples, and can simultaneously test for multiple mutations.

“Hence NGS allows for a more timely initiation of targeted therapy in patients with aNSCLC than SSG, thus facilitating improved treatment outcomes and increased survival rates,” they wrote.

Still, NGS is only available in limited settings in Japan, and the authors said many healthcare providers are unaware of its benefits.

Ogawa and colleagues wanted to see what impact an expansion of NGS might have on overall health care spending (biopsy, testing, and treatment) on patients with advanced NSCLC. They decided to use a budget impact model and compare costs of the current SSG system to one in which NGS was used instead.

At present, though NGS can simultaneously test for a variety of genetic alterations, patients who test positive for MET and NTRK mutations are re-tested using approved diagnostic tests to confirm the results, the authors said. That’s because NGS results have not yet been approved in Japan for diagnosis, but only for research purposes.

Due to the current limitations on NGS, the authors conducted 2 types of comparisons. The first compared SSG to the current paradigm, in which NGS results require re-testing (current NGS). The second analysis compared SSG to the costs that would be associated with NGS in the future, when the authors posited re-testing would not be required (future NGS). The analysis was based on Japanese healthcare costs.

The projections showed that replacing SSG with NGS under the current protocols would result in a small reduction in healthcare spending, of -0.24%. When they looked at adopting NGS in the future scenario, it led to a small increase in spending over a 3-year time horizon, of 4.33%.

Ogawa and colleagues said that increase was likely due to a higher percentage of patients having positive results for MET and NTRK in the future NGS paradigm. Those positive results, in turn, would lead to more expensive targeted therapies. In addition, they noted that many patients in the SSG group would not receive targeted therapy because they would not undergo genetic testing due to unsuccessful biopsies

Still, the investigators said the switch to NGS would have significant benefits for patients, even if it does not result in a cost savings.

“[T]he adoption of future or current NGS over SSG testing would shorten the average turnaround time, enabling faster identification of genomic alterations and earlier initiation of treatment for aNSCLC patients in Japan,” they wrote.


Matsuda H, Ogawa T, Sadatsuki Y, et al. Budget impact analysis of next-generation sequencing versus sequential single-gene testing in Japanese patients with advanced non-small-cell lung cancer. Respir. Investig. 2022. doi:10.1016/j.resinv.2022.10.002

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