Cost-Effectiveness of Next-Generation Sequencing Versus Single-Gene Testing for the Molecular Diagnosis of Patients With Metastatic Non–Small-Cell Lung Cancer From the Perspective of Spanish Reference Centers

Author:

Arriola Edurne1ORCID,Bernabé Reyes2ORCID,Campelo Rosario García3,Biscuola Michele2ORCID,Enguita Ana Belén4,López-Ríos Fernando4ORCID,Martínez Rafael5,Mezquita Laura6ORCID,Palanca Sarai78ORCID,Pareja María Jesús2ORCID,Zugazagoitia Jon491011,Arrabal Natalia12,García J. Francisco12ORCID,Carcedo David13ORCID,de Álava Enrique214ORCID

Affiliation:

1. Hospital del Mar, Barcelona, Spain

2. Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain

3. Hospital Universitario de A Coruña, A Coruña Institute of Biomedicine of A Coruña (INIBIC), A Coruña, Spain

4. Hospital Universitario 12 de octubre, Madrid, Spain

5. Hospital Universitario Virgen de Valme, Sevilla, Spain

6. Hospital Clinic de Barcelona, Barcelona, Spain

7. Hospital Universitario y Politécnico de La Fe, Valencia, Spain

8. University of Valencia, Spain

9. Hospital Universitario 12 de Octubre (i+12), Madrid, Spain

10. Hospital Universitario 12 de Octubre (i+12) / Spanish National Cancer Research Center (CNIO), Madrid, Spain

11. CIBERONC, Madrid, Spain

12. Roche Farma S.A, Madrid, Spain

13. Hygeia Consulting, Madrid, Spain

14. University of Seville, Seville, Spain

Abstract

PURPOSE The aim of this study was to assess the cost-effectiveness of using next-generation sequencing (NGS) versus single-gene testing (SgT) for the detection of genetic molecular subtypes and oncogenic markers in patients with advanced non–small-cell lung cancer (NSCLC) in the setting of Spanish reference centers. METHODS A joint model combining decision tree with partitioned survival models was developed. A two-round consensus panel was performed to describe clinical practice of Spanish reference centers, providing data on testing rate, prevalence of alterations, turnaround times, and treatment pathways. Treatment efficacy data and utility values were obtained from the literature. Only direct costs (euros, 2022), obtained from Spanish databases, were included. A lifetime horizon was considered, so a 3% discount rate for future costs and outcomes was considered. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. RESULTS A target population of 9,734 patients with advanced NSCLC was estimated. If NGS was used instead of SgT, 1,873 more alterations would be detected and 82 more patients could potentially be enrolled in clinical trials. In the long term, using NGS would provide 1,188 additional quality-adjusted life-years (QALYs) in the target population compared with SgT. On the other hand, the incremental cost of NGS versus SgT in the target population was €21,048,580 euros for a lifetime horizon (€1,333,288 for diagnosis phase only). The obtained incremental cost-utility ratios were €25,895 per QALY gained, below the standard cost-effectiveness thresholds. CONCLUSION Using NGS in Spanish reference centers for the molecular diagnosis of patients with metastatic NSCLC would be a cost-effective strategy over SgT.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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