Comprehensive genomic profiling (CGP) versus conventional molecular diagnostic testing of patients with advanced non-small cell lung cancer (NSCLC): Overall survival (OS) and cost in a U.S. health plan population.

Abstract

6599 Background: Molecular diagnostic testing options in NSCLC include conventional testing (specific alterations in single genes or multi-gene panels), and CGP (all classes of genomic alterations—base pair substitutions, copy number, insertions/deletions, and rearrangements in multi-gene panels). Guidelines recommend broad molecular profiling to enable genomic matching with available compendia-based and investigational treatment options. This study estimated the incremental benefits and costs of CGP versus conventional testing of patients with advanced NSCLC. Methods: The impacts of increased use of CGP (via FoundationOne) versus conventional molecular testing on OS and on a commercial US health plan budget were estimated using a decision-analytic model. The number of patients needed to test with CGP to add 1 life year was also estimated. Model inputs were based on published literature (incidence rates, OS associated with drugs indicated for advanced NSCLC), real-world data (testing rates, and biopsy, conventional testing, and medical service costs from administrative claims data analyses), list price of FoundationOne, and assumptions for clinical trial participation. Results: Among 2 million covered lives, an estimated 532 had advanced NSCLC and 266 received molecular diagnostic testing. An increase in CGP use from 2% to 10% (+21 patients receiving CGP) was associated with +2 years in population OS and a budget impact of $0.018 per member per month (PMPM). The budget impact was primarily attributable to changes in drug use, longer treatment, and longer survival (collectively $0.013 PMPM) with the remainder due to CGP cost ($0.005 PMPM). Approximately 11 patients need to be tested with CGP versus conventional molecular diagnostic testing to add 1 life year. Conclusions: An increase in molecular diagnostic testing with CGP versus conventional testing to inform treatment decisions in patients with advanced NSCLC was associated with a gain in OS and a modest health plan budget impact, with most of the added costs attributable to increased use of effective treatments and prolonged survival.