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

作者：Herbert H. Loong, Carlos King Ho Wong, Catherine Chan, Andrea Chang, Zheng‐Yi Zhou, Wenxi Tang, Meaghan Gibbs · 发表于：JTO Clinical and Research Reports · 年份：2022 · DOI：10.1016/j.jtocrr.2022.100290 · 被引用次数：21 · 研究领域：Cancer Genomics and Diagnostics、Lung Cancer Treatments and Mutations、Advances in Oncology and Radiotherapy

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,...