Next-Generation Sequencing Saves Time and Money for Treatment of Metastatic Non-Small Cell Lung Cancer

Biomarker-driven treatment strategies are advancing for metastatic non-small cell lung cancer (mNSCLC). In the past two years, the number of biomarkers has grown from one to four and could increase to six or seven in the next couple of years.

This presents a challenge for physicians as well as government and private insurance organizations: Does it make sense not just medically but also economically to test for each biomarker sequentially or to perform one test — next-generation sequencing (NGS) — for a complete picture of the cancer’s DNA?

That was the question, Nathan Pennell, MD, PhD, staff in the Department of Hematology and Medical Oncology, and colleagues sought to answer by creating a decision analytic model studying four genetic testing scenarios for patients with mNSCLC.

“Traditionally when we had one or two biomarkers, you would do a test and then wait for the results. If it came back positive, you would treat them, and if it came back negative, you would do the next test,” says Dr. Pennell, who will present the results of the model at the 2018 American Society of Clinical Oncology conference.

“But now that we have a minimum of four biomarkers, it has become more difficult to justify doing these tests sequentially,” he says. “Not only does it take time to do each test, you start running out of tissue from their biopsy. So then you have to get a new biopsy to perform more testing. And, of course, each test costs money.”

Four testing approaches

Dr. Pennell and his colleagues created a decision analytic model to illustrate which genetic testing approach was better in terms of cost and time. The model had four different testing arms, and they built a variety of measures into the model including turnaround time for tests, unit costs and mNSCLC prevalence based on literature, public data and expert opinion. In addition, time to receive results and total cost (test + rebiopsy) were calculated for each modality and compared with NGS.

The model estimated that for a hypothetical one million member insurance plan, 2,066 mNSCLC patients with Center for Medicare and Medicaid Services (CMS) insurance and 156 mNSCLC patients with private insurance would need to be tested for genomic alterations. NGS testing saves CMS payers between $1.4 and $2.1 million with proportionate savings for commercial payers. With NGS and hotspot panel testing, patients start therapy 2.8 and 2.7 weeks faster than the sequential and exclusionary options, respectively. The authors concluded that NGS testing in mNSCLC patients saves time and money for patients and payers and identifies faster the appropriate treatment for an individual patient.

Dr. Pennell says part of the impetus for doing the model was to help insurers understand that using NGS will save both time and money. “Historically insurers have resisted covering new technology to do tests,” he says. “We wanted to illustrate that not only is this the right thing to do because patients get timely results to help guide treatment, but ultimately it will cost the insurers less.”