Journal Article Research Support, Non-U.S. Gov't Ppublish 32 citations
PubMed: 35834758 DOI: 10.1200/PO.22.00201
Cost-Effectiveness of Parallel Versus Sequential Testing of Genetic Aberrations for Stage IV Non-Small-Cell Lung Cancer in the Netherlands.
JCO Precis Oncol 6:e2200201
Authors: Henri B Wolff, Elisabeth M P Steeghs, Zakile A Mfumbilwa, Harry J M Groen, Eddy M Adang, Stefan M Willems, Katrien Grünberg, Ed Schuuring, Marjolijn J L Ligtenberg, Bastiaan B J Tops, Veerle M H Coupé
Affiliations
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU Amsterdam, Amsterdam, the Netherlands.
- Department of Pathology, Radboudumc, Nijmegen, the Netherlands.
- Department of Pathology, Antoni van Leeuwenhoek Hospital, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
- Department of Epidemiology, Biostatistics and HTA, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Pathology and Medical Biology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- PALGA Foundation, Houten, the Netherlands.
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Human Genetics, and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
- Princess Máxima Center for Pediatric Oncology, Bilthoven, the Netherlands.
Abstract
PURPOSE
A large number of targeted treatment options for stage IV nonsquamous non-small-cell lung cancer with specific genetic aberrations in tumor DNA is available. It is therefore important to optimize diagnostic testing strategies, such that patients receive adequate personalized treatment that improves survival and quality of life. The aim of this study is to assess the efficacy (including diagnostic costs, turnaround time (TAT), unsuccessful tests, percentages of correct findings, therapeutic costs, and therapeutic effectiveness) of parallel next generation sequencing (NGS)-based versus sequential single-gene-based testing strategies routinely used in patients with metastasized non-small-cell lung cancer in the Netherlands.
METHODS
A diagnostic microsimulation model was developed to simulate 100,000 patients with prevalence of genetic aberrations, extracted from real-world data from the Dutch Pathology Registry. These simulated patients were modeled to undergo different testing strategies composed of multiple tests with different test characteristics including single-gene and panel tests, test accuracy, the probability of an unsuccessful test, and TAT. Diagnostic outcomes were linked to a previously developed treatment model, to predict average long-term survival, quality-adjusted life-years (QALYs), costs, and cost-effectiveness of parallel versus sequential testing.
RESULTS
NGS-based parallel testing for all actionable genetic aberrations is on average €266 cheaper than single-gene-based sequential testing, and detects additional relevant targetable genetic aberrations in 20.5% of the cases, given a TAT of maximally 2 weeks. Therapeutic costs increased by €8,358, and 0.12 QALYs were gained, leading to an incremental cost-effectiveness ratio of €69,614/QALY for parallel versus sequential testing.
CONCLUSION
NGS-based parallel testing is diagnostically superior over single-gene-based sequential testing, as it is cheaper and more effective than sequential testing. Parallel testing remains cost-effective with an incremental cost-effectiveness ratio of 69,614 €/QALY upon inclusion of therapeutic costs and long-term outcomes.
MeSH
Research Design, Carcinoma, Non-Small-Cell Lung, Cells, Therapeutics, Lung Neoplasms, Precision Medicine, Small Cell Lung Carcinoma, Genes, Quality-Adjusted Life Years, High-Throughput Nucleotide Sequencing
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