Real-World Utilization of Biomarker Testing for Patients with Advanced Non–Small Cell Lung Cancer in a Tertiary Referral Center and Referring Hospitals

Michiel Van De Ven,Hendrik Koffijberg,Valesca Retèl,Kim Monkhorst,Egbert Smit,Wim Van Harten,Maarten Ijzerman

doi:10.1016/j.jmoldx.2021.01.004

Abstract

The continued introduction of biomarkers and innovative testing methods makes already complex diagnosis in patients with stage IV non-small-cell lung cancer (NSCLC) even more complex. This study primarily analyzed variations in biomarker testing in clinical practice in patients referred to a comprehensive cancer center in the Netherlands. The secondary aim was to compare the cost of biomarker testing with the cost of whole-genome sequencing. The cohort included 102 stage IV NSCLC patients who received biomarker testing in 2017 or 2018 at the comprehensive cancer center. The complete biomarker testing history of the cohort was identified using linked data from the comprehensive cancer center and the nationwide network and registry of histopathology and cytopathology in the Netherlands. Unique biomarker-test combinations, costs, turnaround times, and test utilization were examined. The results indicate substantial variation in test utilization and sequences. The mean cost per patient of biomarker testing was 2259.92 ± 1217.10 USD, or 1881.23 ± 1013.15 EUR. Targeted gene panels were most frequently conducted, followed by IHC analysis for programmed cell death protein ligand 1. Typically, the most common biomarkers were assessed within the first tests, and emerging biomarkers were tested further down the test sequence. At the cost of current biomarker testing, replacing current testing with whole-genome sequencing would have led to cost-savings in only two patients (2%).

Highlights

The turnaround time of biomarker testing directly influences the time at which a patient can be started on treatment.[6]
Across all nonesmall-cell lung cancer (NSCLC) patient subgroups, 2% to 7% of patients harbor an ALK translocation, 3% to 5% of patients harbor a BRAF V600E mutation, and ROS1 rearrangements can be detected in 1% to 2% of patients
While next-generation sequencing (NGS), and whole-genome sequencing (WGS), can increase efficiency by substituting all other tests used for biomarker testing, WGS is more expensive compared to other biomarker tests,15e18 which is one of the reasons that it is not yet widely used in clinical practice

Summary

Introduction

The turnaround time of biomarker testing directly influences the time at which a patient can be started on treatment.[6]. Relatively little detailed information about the use of biomarker testing in clinical practice, including its contribution to the total cost of the diagnostic pathway, is available. This information would add essential information, as previous budget-impact studies of biomarker testing in lung cancer have reported aggregated measures, such as health care resource utilization.19e21 other relevant information, such as how tests are sequenced,[22] test techniques used,[6,23] and the actual costs of these test sequences, is not yet fully known

Methods

Results

Conclusion