Budget Impact of Next-Generation Sequencing for Molecular Assessment of Advanced Non–Small Cell Lung Cancer

Autor: Carl Morrison, Tiffany M. Yu, Renée J.G. Arnold, Edward J. Gold, Alison Tradonsky
Rok vydání: 2018
Předmět:
Budgets
Oncology
medicine.medical_specialty
Palliative care
Cost-Benefit Analysis
medicine.medical_treatment
law.invention
Targeted therapy
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Carcinoma
Non-Small-Cell Lung
Internal medicine
Epidemiology
Health care
Prevalence
medicine
Humans
Genetic Testing
030212 general & internal medicine
Precision Medicine
Lung cancer
Lung
health care economics and organizations
Aged
Genetic testing
Aged
80 and over
Insurance
Health
medicine.diagnostic_test
business.industry
Health Policy
Public Health
Environmental and Occupational Health
Health Care Costs
Sequence Analysis
DNA
medicine.disease
Survival Analysis
Markov Chains
United States
Clinical trial
030220 oncology & carcinogenesis
Mutation
Disease Progression
business
Genes
Neoplasm
Zdroj: Value in Health. 21:1278-1285
ISSN: 1098-3015
DOI: 10.1016/j.jval.2018.04.1372
Popis: Background Genetic testing for nonsquamous advanced non–small cell lung cancer (aNSCLC) is recommended to guide first-line therapy. Activating mutations can be identified via single-gene testing or next-generation sequencing (NGS). Objectives To evaluate the budget impact of NGS instead of single-gene testing for tissue-based molecular assessment of aNSCLC from the US health care payer perspective. Methods An annual cohort of newly diagnosed patients with nonsquamous aNSCLC in a hypothetical 1-million-member health care plan was evaluated using a Markov model over 5 years. Epidemiology and testing rates (EGFR, ALK, ROS1, BRAF, MET, HER2, and RET) were from the literature. Treatments were determined by available genetic information. Safety, progression, and survival with targeted therapy or chemotherapy were from randomized clinical trials. Single-gene testing and first-line and maintenance treatment costs were from RED BOOK and Medicare fee schedules; NGS testing, adverse event, and progression costs to payers were from the literature. Results Three hundred sixteen testing-eligible patients with aNSCLC were expected annually, of whom 179 undergo genetic testing. Of 57 patients expected to have activating mutations, single-gene testing identified 35, whereas NGS identified 54. NGS, instead of single-gene testing, decreased expected testing procedure–related costs to the health plan payer by $24,651. First-line and maintenance treatment costs increased by $842,205, offset by a $385,000 decrease in second-line treatment and palliative care costs. Over 5 years, total budget impact was $432,554 ($0.0072 per member per month). Conclusions NGS is expected to identify more patients with activating mutations, thereby better enabling selection for targeted therapy and clinical trial enrollment. The budget impact to US payers is expected to be minimally cost-additive.
Databáze: OpenAIRE
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