A cost-effectiveness analysis model of actionable genomic alteration testing strategies incorporating different modalities and sizes of next-generation sequencing panels in non-small-cell lung cancer

作者：Y. Ang, Jian Chun Matthew Ong, Y. Huang, Jia Li Low, Kenneth Sooi, Jorn Nützinger, Xiao Jun Wang, Meaghan Gibbs, Boon Cher Goh, Ross A. Soo · 发表于：Therapeutic Advances in Medical Oncology · 年份：2025 · DOI：10.1177/17588359251405616 · 被引用次数：1 · 研究领域：Lung Cancer Treatments and Mutations、Cancer Genomics and Diagnostics、Genomic variations and chromosomal abnormalities

Background: Prompt identification of actionable genomic alterations (AGAs) is essential in guiding treatment decisions in newly diagnosed advanced non-small-cell lung cancer (NSCLC). Objectives: We aimed to determine the optimal testing strategy in terms of proportion of AGAs detected, time-to-treatment decision (TTTD) and average costs/patient in Singapore, a high-frequency AGA population. Design: A model was constructed to evaluate AGA testing strategies, comparing the cost-effectiveness and budget impact of each strategy. Methods: The 24 strategies studies included (1) upfront tissue/plasma next-generation sequencing (NGS) alone (small/medium/large panel), (2) exclusionary tissue single-gene testing (EGFR, ALK and ROS1) followed by tissue/plasma NGS, (3) exclusionary plasma EGFR followed by tissue or plasma NGS, (4) sequential single-gene testing followed by tissue/plasma NGS, (5) exclusionary or sequential testing without NGS and (6) small panel tissue NGS with fluorescence in situ hybridization (FISH) for ALK, ROS1, RET and MET. Literature review was performed to determine the incidence of NSCLC and the prevalence of each AGA in the population; costs, gene coverage and turnaround times were sourced through market research. Results: AGAs and EGFR mutations occurred in 76.7% and 56.0% of patients, respectively. Upfront medium panel tissue NGS detected all AGAs at USD1813/patient, with a TTTD of 7 days-no benefit was seen from using large panel tissue NGS at a higher cost. ...