Abstract
Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc). However, newer testing options such as comprehensive genomic profiling (cgp) offer improved detection rates and identification of multiple classes of genomic alterations in a single assay, minimizing tissue requirements and turnaround time. The objective of the present analysis was to assess the health and budget impacts of adopting cgp testing for nsclc in Canada. This study assessed the impact of funding the cgp tests FoundationOne CDx and FoundationOne Liquid (Foundation Medicine, Cambridge, MA, U.S.A.) over a 3-year time horizon using a Canadian societal perspective for Ontario. Conventional testing strategies were summarized into two reference scenarios: a series of single-gene tests only, and reflex single-gene testing followed by a hotspot panel for negative results. Four adoption scenarios for cgp testing were considered: replacing all single-gene and hotspot panel testing, replacing hotspot panel testing only, use after negative single-gene and hotspot testing, and use of FoundationOne Liquid in individuals with insufficient tissue for conventional testing. When cgp testing was assumed to replace all conventional testing with 50% uptake, the budget impact per person per year ranged from $0.71 to $0.87, depending on the reference scenario, with a 3-year gain of 680.9 life-years and 3831 working days over the full cohort. Given the present testing landscape for patients with nsclc in Canada, listing cgp testing could optimize the selection of appropriately targeted treatments, and thus add life-years and productivity for this population, with a minimal budget impact.
Highlights
Lung cancer is the most common cause of cancer-related death in Canada, and more than 80% of lung cancer cases are non-small-cell lung cancer[1]
Given the present testing landscape for patients with nsclc in Canada, listing cgp testing could optimize the selection of appropriately targeted treatments, and add life–years and productivity for this population, with a minimal budget impact
Adoption scenarios were all associated with fewer total tests per person (Appendix 1, Table 5, in the supplemental material), for reference scenario 1, in which the initial series of single-gene tests is replaced by a single FoundationOne CDx test
Summary
Lung cancer is the most common cause of cancer-related death in Canada, and more than 80% of lung cancer cases are non-small-cell lung cancer (nsclc)[1]. Current genomic testing in Canada uses a combination of single-gene testing methods such as polymerase chain reaction, Sanger sequencing, fluorescence in situ e569 hybridization, and immunohistochemistry, and multi-gene testing, which typically uses next-generation sequencing hotspot panels. 65% of tumours deemed by single-gene testing methods to be negative for a driver alteration were subsequently found to have clinically-relevant and actionable alterations[8], and 58% of patients who tested negative for EGFR, KRAS, and ALK had clinically relevant alterations suggesting potential for benefit from targeted therapy[9]. Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc).
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