Janssen Scientific Affairs, LLC, Horsham, PA, USA.
Janssen Global Services, Inc, Raritan, NJ, USA.
J Med Econ. 2022 Jan-Dec;25(1):457-468. doi: 10.1080/13696998.2022.2053403.
To assess the total cost of testing associated with next-generation sequencing (NGS) versus polymerase chain reaction (PCR) testing strategies among patients with metastatic non-small cell lung cancer (mNSCLC) from a Medicare and US commercial payer's perspective.
A decision tree model considered testing for genomic alterations in EGFR, ALK, ROS1, BRAF, KRAS, MET, HER2, RET, NTRK1 among patients with newly diagnosed mNSCLC using (1) liquid or tissue biopsy NGS tests, (2) exclusionary mutation (KRAS) test followed by sequential PCR tests, (3) sequential PCR tests, or (4) hotspot panel PCR tests. The alteration test sequence followed clinical guideline recommendations. Inputs based on literature, expert opinion, or assumptions included prevalence of mNSCLC, proportion of patients using each testing strategy (50% NGS [90% tissue, 10% liquid], 10% exclusionary, 10% sequential, 30% hotspot), proportion testing positive for each genomic mutation, rebiopsy rates, and costs for testing and associated medical care. Time to appropriate targeted therapy initiation and total costs were calculated for NGS, each PCR testing strategy, and all PCR strategies combined.
Among a hypothetical plan of 1,000,000 members (75% commercial, 25% Medicare), 1,119 patients were estimated to have mNSCLC and be eligible for testing. Estimated mean time to appropriate targeted therapy was 2 weeks for NGS and 6 weeks for PCR (sequential: 9 weeks, exclusionary: 8 weeks, hotspot: 3 weeks). Mean per patient costs were $4,932 for NGS and $6,605 for PCR (exclusionary: $5,563, sequential: $6,263, hotspot: $7,066). Per patient costs were higher from a commercial perspective (NGS: $6,225; PCR: $8,430) relative to Medicare (NGS: $2,099; PCR: $2,646); nevertheless, NGS was the least costly testing strategy across plan types.
NGS was associated with the fastest time to appropriate targeted therapy initiation and lowest total cost of testing compared to PCR testing strategies for newly diagnosed patients with mNSCLC.
从医疗保险和美国商业支付者的角度评估下一代测序（NGS）与聚合酶链反应（PCR）检测策略在转移性非小细胞肺癌（mNSCLC）患者中的检测相关总成本。
决策树模型考虑了使用（1）液体或组织活检 NGS 检测、（2）排除性突变（KRAS）检测后序贯 PCR 检测、（3）序贯 PCR 检测或（4）热点面板 PCR 检测对新诊断的 mNSCLC 患者进行 EGFR、ALK、ROS1、BRAF、KRAS、MET、HER2、RET、NTRK1 基因改变检测。改变检测序列遵循临床指南建议。基于文献、专家意见或假设的输入包括 mNSCLC 的患病率、每位患者使用每种检测策略的比例（50%NGS[90%组织，10%液体]、10%排除性、10%序贯性、30%热点性）、每种基因变异的阳性检测比例、再活检率以及检测和相关医疗保健费用。计算了 NGS 和每种 PCR 检测策略以及所有 PCR 策略组合的适当靶向治疗起始时间和总费用。
在一个假设的 100 万成员计划（75%商业，25%医疗保险）中，估计有 1119 名患者患有 mNSCLC 且有资格进行检测。估计适当靶向治疗的平均时间为 NGS 为 2 周，PCR 为 6 周（序贯：9 周，排除性：8 周，热点：3 周）。每位患者的平均费用为 NGS 为 4932 美元，PCR 为 6605 美元（排除性：5563 美元，序贯性：6263 美元，热点性：7066 美元）。从商业角度来看，每位患者的成本更高（NGS：6225 美元；PCR：8430 美元），而不是医疗保险（NGS：2099 美元；PCR：2646 美元）；然而，NGS 是所有计划类型中成本最低的检测策略。
与 PCR 检测策略相比，NGS 与新诊断的 mNSCLC 患者适当靶向治疗起始时间最快，检测总成本最低。
