Broadstreet Health Economics and Outcomes Research, HEOR, Vancouver, Canada.
Laboratory Medicine, William Osler Health System, Brampton, Canada.
J Med Econ. 2020 Oct;23(10):1123-1129. doi: 10.1080/13696998.2020.1789152. Epub 2020 Jul 14.
Genomic profiling in oncology is vital for determining eligible patients for mutation-specific targeted therapies. Use of commercial genomic testing has the potential to improve patient outcomes. Economic evaluations of in-house genomic profiling typically only include material costs while external commercial services include many other factors. Using non-small cell lung cancer (NSCLC) as an example, this study sought to characterize the unique challenges of costing testing services and their impact on results of economic evaluations.
Structured interviews with Canadian oncologists, pathologists, and laboratory directors were conducted to identify material and non-material costs associated with genomic-testing laboratories to allow estimation of a more complete cost of in-house testing, with NSCLC cost-per-test calculated using annual operational costs and NSCLC-specific testing volume. A health and budget impact model of in-house versus external commercial profiling services was used to compare the impact of non-material costs on results.
In-house testing costs, limited to materials, was $133/single-gene test and $1,400/panel. For a laboratory running 1,300 in-house tests/year, total annual non-material costs included equipment maintenance ($6,842), labor ($502,313; technicians, administrative, and medical staff), shipping/reporting and software updates ($146,050), for an additional $519/test. The combined cost of $652/single-gene and $1,919/panel was compared to a cost of $6,194 for a commercial external test. Based on current Canadian testing patterns and anticipated utilization of external testing, inclusion of in-house non-material costs reduced the estimated 3-year budget impact by 12%.
When conducting economic evaluation to assess the value of introducing external tests, it is critical that non-material costs of standard testing strategies be measured and incorporated.
肿瘤学中的基因组分析对于确定适合突变特异性靶向治疗的患者至关重要。商业基因组检测的使用有可能改善患者的预后。内部基因组分析的经济评估通常仅包括材料成本，而外部商业服务则包括许多其他因素。本研究以非小细胞肺癌（NSCLC）为例，旨在描述测试服务成本核算的独特挑战及其对经济评估结果的影响。
对加拿大肿瘤学家、病理学家和实验室主任进行了结构化访谈，以确定与基因组检测实验室相关的材料和非材料成本，从而可以更全面地估算内部检测的成本，使用年度运营成本和 NSCLC 特定检测量计算 NSCLC 检测的单位成本。采用内部与外部商业分析服务的健康和预算影响模型，比较非材料成本对结果的影响。
仅限于材料的内部检测成本为每个单基因检测 133 美元，每个检测组 1400 美元。对于每年进行 1300 次内部检测的实验室，每年的非材料总成本包括设备维护（6842 美元）、劳动力（技术人员、行政和医务人员 502313 美元）、运输/报告和软件更新（146050 美元），每个检测增加 519 美元。单个基因 652 美元和检测组 1919 美元的综合成本与商业外部检测的 6194 美元成本进行了比较。基于目前加拿大的检测模式和对外包检测的预期使用，内部非材料成本的纳入将估计的 3 年预算影响降低了 12%。
在进行经济评估以评估引入外部检测的价值时，必须衡量和纳入标准检测策略的非材料成本。
