Background: Advancements in next-generation sequencing (NGS) show promise in further individualizing cancer therapy. To ensure appropriate diffusion and use of NGS in clinical practice it is necessary to assess the value of NGS in supporting evidence-based decision making.
Aim: To identify parameters that are important drivers of the cost-effectiveness of NGS, by comparing the use of NGS to select targeted therapy based on an individual’s genomic profile versus no (further) testing and best supportive care in lung adenocarcinoma patients who have progressed on standard treatment regimes.
Methods: A combined decision tree and Markov model was developed to compare costs and quality-adjusted life-years over a life-time horizon from the Australian health-care payer perspective. A population-based molecular cohort (Cancer 2015) and the published literature were used as the main sources of data. Comprehensive sensitivity and scenario analyses were used to explore the impact of uncertainty on cost-effective estimates and which parameters are key drivers of uncertainty.
Results: Given the current evidence base, the cost-effectiveness of NGS is questionable. Uncertainty surrounding a number of parameters likely to impact the cost-effectiveness of NGS has been identified, including the probability of having an actionable mutation, NGS turn-around time, survival after entering genomic directed trials and the personal utility of genomic information. Evidence concerning these parameters is currently naïve but this is likely to change. The effect of the expanding evidence base will be tested by re-running the analysis just prior to the meeting; to highlight how a maturing evidence base can impact the results of a cost-effectiveness analysis over time.
Conclusions: Innovative funding approaches are likely to be required in facilitating the most appropriate diffusion of NGS into clinical care. An iterative process to the economic evaluation of NGS will be necessary as our understanding of its impact on health outcomes (and the health budget) improves.