Supporting Biomarker-Driven Therapies in Oncology: A Genomic Testing Cost Calculator

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  • Albrecht Stenzinger
  • Brian Cuffel
  • Noman Paracha
  • Eric Vail
  • Jesus Garcia-Foncillas
  • Clifford Goodman
  • Lassen, Ulrik Niels
  • Gilles Vassal
  • Sean D. Sullivan

Background: Adoption of high-throughput, gene panel-based, next-generation sequencing (NGS) into routine cancer care is widely supported, but hampered by concerns about cost. To inform policies regarding genomic testing strategies, we propose a simple metric, cost per correctly identified patient (CCIP), that compares sequential single-gene testing (SGT) vs. multiplex NGS in different tumor types. Materials and Methods: A genomic testing cost calculator was developed based on clinically actionable genomic alterations identified in the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets. Using sensitivity/specificity data for SGTs (immunohistochemistry, polymerase chain reaction, and fluorescence in situ hybridization) and NGS and marker prevalence, the number needed to predict metric was monetarized to estimate CCIP. Results: At base case, CCIP was lower with NGS than sequential SGT for advanced/metastatic non-squamous non-small cell lung cancer (NSCLC), breast, colorectal, gastric cancers, and cholangiocarcinoma. CCIP with NGS was also favorable for squamous NSCLC, pancreatic, and hepatic cancers, but with overlapping confidence intervals. CCIP favored SGT for prostate cancer. Alternate scenarios using different price estimates for each test showed similar trends, but with incremental changes in the magnitude of difference between NGS and SGT, depending on price estimates for each test. Conclusions: The cost to correctly identify clinically actionable genomic alterations was lower for NGS than sequential SGT in most cancer types evaluated. Decreasing price estimates for NGS and the rapid expansion of targeted therapies and accompanying biomarkers are anticipated to further support NGS as a preferred diagnostic standard for precision oncology.

OriginalsprogEngelsk
TidsskriftOncologist
Vol/bind28
Udgave nummer5
Sider (fra-til)e242-e253
ISSN1083-7159
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
This study was supported by Bayer.

Funding Information:
Medical writing assistance was provided by Ingrid Koo, PhD, of FleishmanHillard and funded by Bayer Pharmaceuticals. Cytel, Inc. conducted the targeted literature review and analysis.

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press.

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