Multigene panel sequencing (MGPS) for patients with advanced non-small cell lung cancer (NSCLC) is moderately more cost-effective than standard-of-care, single-gene tests, according to a recent economic modeling study.1 The study determined that MGPS could deliver even greater value if patients with test results identifying actionable genetic mutations consistently received guided treatments.

The results of the study, which was commissioned by the Personalized Medicine Coalition (PMC), underline the need to align clinical practices with an era of personalized medicine in which physicians can use diagnostic tests to identify specific biological markers that inform targeted prevention and treatment plans.

Pritchard

Daryl Pritchard, PhD, Personalized Medicine Coalition.

The study analyzed the clinical and economic value of using MGPS to identify patients with tumors that over-express genetic mutations that could be targeted by available therapies designed to inhibit the function of those genes. Using data provided by the cancer research company Flatiron Health, New York City, researchers examined clinical and cost information on 5,688 patients with advanced NSCLC who were treated between 2011 and 2016. The patients were separated into cohorts of those who received MGPS tests that assess at least 30 genetic mutations at once, and those who received only single-marker genetic testing of less than 30 genes.

The MGPS testing strategy, including downstream treatment and monitoring of disease, incurred costs equal to $148,478 for each year of quality life that it facilitated. This metric is a measure of cost per quality-adjusted life year (QALY). If the QALY cost is less than $150,000, most US health economists accept the treatment as cost-effective.

The authors of the study point out, however, that physicians prescribed a targeted therapy to only some of the patients whose MGPS test results revealed actionable mutations. MGPS can only improve downstream patient outcomes if actionable results are used to put the patient on a targeted treatment regimen that is more effective than the therapy they would otherwise have been prescribed. It is therefore impossible for the cost of an MGPS test to translate into improved QALYs if actionable test results do not bring about the selection of a targeted treatment regimen.

Although MGPS testing revealed actionable mutations in 30.1% of the patients in the study cohort, only 21.4% of patients who underwent MGPS testing received a targeted treatment.

Abrahams

Edward Abrahams, PhD, Personalized Medicine Coalition.

The study’s authors calculated that if all MGPS-tested patients with actionable mutations had received a targeted therapy, MGPS testing would deliver a QALY at a more definitively cost-effective expense of $110,000.

“This research underlines the importance of ensuring that clinical practices keep pace with scientific progress in personalized medicine, so that we can maximize the benefits of diagnostic tests that can improve patient care and make the health system more efficient by ensuring that safe and effective targeted therapies are prescribed to those patients who will benefit,” says Edward Abrahams, PhD, PMC president.

For more information, visit the Personalized Medicine Coalition.

Reference

  1. Steuten L, Goulart B, Meropol NJ, Pritchard D, Ramsey SD. Cost-effectiveness of multigene panel sequencing for patients with advanced non-small cell lung cancer. JCO Clin Cancer Inform. 2019;3:1–10; doi: 10.1200/cci.19.00002.

Featured image:

Healthcare image © Oleg Dudko courtesy Dreamstime (ID 118509078).