Nathan A. Pennell
The use of upfront next-generation sequencing was more cost-effective and faster than single-gene testing methods among patients with newly diagnosed metastatic non-small cell lung cancer, according to results of a hypothetical cohort study scheduled for presentation at the ASCO Annual Meeting.
Sequencing saved up to $2.1 million in panel genetic testing for CMS-insured patients and more than $250,000 for commercially insured patients, the research showed.
“Sequential single gene tests are time consuming and have potential to use up tissue and require repeat biopsy whereas next-generation sequencing testing can be done all at once with short turnaround time,” Nathan A. Pennell, MD, PhD, codirector of the Cleveland Clinic lung cancer program, said during a press cast.
Genomic testing is standard of care to detect oncogenic drivers to assist with treatment decisions with many tests available, Pennell said. However, no universal standard exists for when, how or which test should be used.
Pennell and colleagues used data from CMS and U.S. commercial health plans to estimate and compare costs for multiple PD-L1 and genetic alteration tests used to identify commonly known lung cancer-related genes: EGFR, ALK, ROS1, BRAF, MET, HER2, RET and NTRK1.
Researchers used hypothetical 1-million-member plans for the analytic model and estimated that 2,066 patients with Medicare and 156 with commercial health plans would undergo testing for genetic alterations.
Patients underwent one of four testing approaches:
- upfront next-generation sequencing for all NSCLC-related genes;
- sequential tests, where one gene was tested at a time;
- exclusionary KRAS tests, followed by sequential tests if KRAS was not mutated; or
- panel testing for combined EGFR, ALK, ROS1 and BRAF genes, followed by single-gene testing or next-generation sequencing.
Researchers compared the total cost, which included test and rebiopsy, of each test with next-generation sequencing.
For Medicare-insured patients, the total cost was $3,721,368 for sequential testing; $3,584,177 for exclusionary testing; and $4,331,295 for panel testing compared with $2,190,499 for next-generation sequencing.
Analysis of CMS reimbursement indicated a cost savings for next-generation sequencing of $1,530,869 compared with sequential testing, $1,393,678 compared with exclusionary testing and $2,140,795 compared with panel testing.
Under commercial insurance plans, the total cost was $747,771 for sequential testing, $624,178 for exclusionary testing and $871,211 for panel testing, compared with $620,369 for next-generation sequencing.
Analysis of commercial plan reimbursement showed a cost savings with next-generation sequencing of $127,402 compared with sequential testing, $3,809 compared with exclusionary testing and $250,842 compared panel testing.
Next-generation sequencing also reduced the time to receive results, which could lead to quicker initiation of treatment. Estimated time to receive next-generation sequencing results was 2 weeks.
“With next-generation sequencing ... patients initiate therapy 2.8 and 2.7 weeks faster than sequential and exclusionary, respectively,” Pennell said. “Waiting a month or longer [for results] is no longer viable for these patients.” – by Melinda Stevens
Pennell NA, et al. Abstract 9031. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosures: Pennell reports consultant/advisory roles with AstraZeneca, Lilly and Regeneron and research funding for his institution from Astex Pharmaceuticals, AstraZeneca, Celgene, Clovis Oncology, Genentech, Merck, Newlink Genetics and Pfizer. Please see the abstract for all other authors’ relevant financial disclosures.