Centre for Reviews and Dissemination, University of York, York, England, UK.
Centre for Reviews and Dissemination, University of York, York, England, UK; Centre for Health Economics, University of York, UK.
Value Health. 2022 Jul;25(7):1133-1140. doi: 10.1016/j.jval.2021.11.1359. Epub 2021 Dec 17.
Histology-independent (HI) technologies are authorized for patients with advanced or metastatic cancer if they express a particular biomarker regardless of its position in the body. Although this represents an important advancement in cancer treatment, genomic testing to identify eligible individuals for HI technologies will require substantial investment and impact their cost-effectiveness. Estimating these costs is complicated by several issues, which affect not only the overall cost of testing but also the distribution of testing costs across tumor types.
Key issues that should be considered when evaluating the cost of genomic testing to identify those eligible for HI technologies are discussed. These issues are explored in illustrative analyses where costs of genomic testing for NTRK fusions in England for recently approved HI technologies are estimated.
The prevalence of mutation, testing strategy adopted, and current testing provision affect the cost of identifying eligible patients. The illustrative analysis estimated the cost of RNA-based next-generation sequencing to identify 1 individual with an NTRK fusion ranged between £377 and £282 258. To improve cost-effectiveness, testing costs could be shared across multiple technologies. An estimated additional ∼4000 patients would need to be treated with other HI therapies for testing in patients with advanced or metastatic cancer to be cost-effective.
The cost of testing to identify individuals eligible for HI technologies affect the drug's cost-effectiveness. The cost of testing across tumor types varies owing to heterogeneity in the mutation's prevalence and current testing provision. The cost-effectiveness of HI technologies may be improved if testing costs could be shared across multiple agents.
如果表达特定生物标志物的晚期或转移性癌症患者不受其体内位置的影响，组织学独立（HI）技术可获得授权。尽管这代表了癌症治疗的重要进展，但用于确定 HI 技术合格个体的基因组测试需要大量投资，并会影响其成本效益。由于几个问题的影响，不仅会影响测试的总成本，还会影响肿瘤类型之间的测试成本分布，因此估计这些成本非常复杂。
讨论了评估用于识别 HI 技术合格个体的基因组测试成本时应考虑的关键问题。在说明性分析中探讨了这些问题，其中估算了英格兰最近批准的 HI 技术中 NTRK 融合的基因组测试成本。
突变的流行率、采用的测试策略和当前的测试提供情况会影响确定合格患者的成本。说明性分析估计，使用 RNA 为基础的下一代测序来鉴定 1 名 NTRK 融合个体的成本在 377 英镑至 282258 英镑之间。为了提高成本效益，可以跨多种技术共享测试成本。需要估计额外治疗约 4000 名晚期或转移性癌症患者，以使 HI 治疗的测试具有成本效益。
鉴定有资格使用 HI 技术的个体的测试成本会影响药物的成本效益。由于突变流行率和当前测试供应的异质性，肿瘤类型之间的测试成本存在差异。如果可以跨多种药物共享测试成本，则可以提高 HI 技术的成本效益。
