Impact of Comprehensive Genomic Profiling of Patients With First Line Non-Small Cell Lung Cancer In The UK

Abstract

To estimate the impact of increased use of Comprehensive Genomic Profiling (CGP) together with targeted and immuno-therapies consistent with NCCN Guidelines®, versus conventional molecular diagnostic testing, on cost and overall survival (OS) in the UK. A 5-year budget impact forecasting model was developed to determine the financial implications of incorporating CGP to guide first-line treatment options in an incident cohort of patients with advanced lung carcinoma. Costs including molecular diagnostics, associated medical and treatment expenses were calculated for the duration of first-line treatment. Future treatment regimens were forecasted based on published biomarker status. Costs were identified from literature and technology assessment reports. Extensive sensitivity analyses were conducted to investigate the impact of key model parameters on results. The incremental budget impact with 10% uptake of CGP was estimated to be £0.02 per member per month. This increased usage of CGP equates to a net total budget impact of £17.5M for eligible patients in the UK (15% related to cost of CGP;62% due to treatment costs;23% costs due to improved survival). Number-Needed-to-Treat for 1 additional life year is approximately 3 patients. Patients receiving CGP had longer survival by 2.62 months. Cost offsets are achieved in repetitive biopsy procedures and non-matched drug treatment costs. That is in contrast to increases in costs of molecular testing and matched drug treatment costs. CGP may be an affordable option to identify the most appropriate treatment regimen for an individual patient. Further research is warranted better understand how current therapies can be best utilized to improve overall survival. Furthermore, health systems may need to move from a tumour type based treatment approach to a mutation specific based indication as mounting evidence suggest cancer is driven by genomically matched indications rather than anatomical location.