Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia

Herbert H Loong; Carlos K H Wong; Catherine P K Chan; Andrea Chang; Zheng-Yi Zhou; Wenxi Tang; Meaghan Gibbs

doi:10.1016/j.jtocrr.2022.100290

Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia

JTO Clin Res Rep. 2022 Feb 14;3(3):100290. doi: 10.1016/j.jtocrr.2022.100290. eCollection 2022 Mar.

Authors

Herbert H Loong¹, Carlos K H Wong^{2

3}, Catherine P K Chan⁴, Andrea Chang⁴, Zheng-Yi Zhou⁵, Wenxi Tang⁶, Meaghan Gibbs⁷

Affiliations

¹ Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.
² Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
³ Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁴ Novartis Pharmaceuticals Corporation, Hong Kong SAR, China.
⁵ Analysis Group, Inc., London, United Kingdom.
⁶ Analysis Group, Inc., Dallas, Texas.
⁷ Novartis Pharmaceuticals Corporation, Dubai, United Arab Emirates.

Abstract

Introduction: Upfront next-generation sequencing (NGS) in patients with metastatic NSCLC has been associated with cost savings and shorter time-to-test results in the United States. Nevertheless, this may not apply in jurisdictions where the prevalence of patients with actionable mutations, cost of health care, and reimbursement models differ.

Methods: A decision analytical model was built to compare sequential, panel, exclusionary, and upfront NGS testing in patients with metastatic NSCLC in Hong Kong. In sequential and panel testing, patients were tested for genomic alterations (GAs) with treatment followed by sequential or NGS. In exclusionary testing, EGFR and ALK were tested first, followed by NGS. For each modality, the mutation identified, time to receive testing results, and costs (2020 U.S. dollars) were estimated.

Results: Exclusionary testing required the shortest time-to-results (1.6 wk) and was most cost saving. In the scenario where all patients used exclusionary testing, a cost saving of $4.6 million was expected relative to current practice, with 90.7% of actionable and 46.5% of nonactionable GAs detected; when all patients used NGS, it would be $2.9 million more expensive with a 100% GA detection rate. Results were sensitive to testing costs and the proportion of patients that continued testing.

Conclusions: Exclusionary testing is the best option in terms of cost and time-to-results in Hong Kong. This finding may be applicable for other Asian countries; however, exclusionary testing does not capture all possible GAs. As more GAs become actionable and the cost of NGS declines, NGS may become a cost-saving option.

Keywords: East Asia; Economic impact; Genomic alteration; Metastatic NSCLC; Next-generation sequencing.