Johnson, MD, FASCO, and co-moderator of the presscast.Ī budget impact model was included in the study, which showed that increasing the percentage of patients tested by NGS versus other strategies lead to consistent decreases in cost to payers overall.įor 1 million-member health plans, investigators suggested that 2066 tests would be paid for by CMS and 156 would be paid for by commercial insurers. "One of the things that is a real challenge is going back to resequence, or if a new emerges," said ASCO president Bruce E. NGS identified a higher percentage of patients with targetable alterations, as each of the single-gene test strategies included patients dropping off and never having their alteration identified due to exhausted tissue. NGS testing can be done all at once, resulting in the shortest turnaround time. In addition to sequential single-gene tests being deemed time consuming, they have the potential to use up tissue and DNA, often requiring a repeat biopsy. Although, Pennell said that many patients would not be able to undergo a rebiopsy. Investigators also considered that after each individual test, a certain percentage of patients would have exhausted their tissue and need to go onto another biopsy. After those initial tests were done, 50% of patients went on to broader testing for potential alterations that might lead to a clinical trial, Pennell said.įor NGS and panel, estimated time to receive results was 2 weeks, which is 2.7 and 2.8 weeks faster than exclusionary and sequential, respectively. Notably, the single-gene testing focused only on the alterations that have led to FDA-approved therapies- EGFR, ALK, ROS1, and BRAF. The third testing modality was panel, where single-gene tests were all done at the same time, rather than sequentially. Since that is the most common mutation, 25% of patients who were positive could be excluded from needing further testing. Exclusionary testing was similar to sequential, but it started with KRAS mutations. Sequential testing first identified EGFR mutations, and once those results were received, patients would either be treated or move onto the next test, with a certain number of patients dropping off because of exhausted tissue, which required a rebiopsy. NGS is a single test that can concurrently test for EGFR, ALK, ROS1, BRAF, KRAS, MET, HER2, RET, and NTRK1 gene alterations, among others. If negative, the patient received standard therapy. If a patient was positive for an alteration after undergoing one of these tests, they moved onto targeted therapy. The 4 genetic testing strategies included in the study were NGS, sequential, exclusionary, and panel. There are multiple other genomic alterations including MET, HER2, RET, and NTRK, which have each shown responses to targeted therapies in clinical trials. There are 4 genomic alterations in NSCLC that have FDA-approved therapies associated with them- EGFR, ALK, ROS1, and BRAF mutations. Waiting a month or longer is simply no longer viable for patients because these treatments work very well and they get sick very quickly." "NGS had a faster turnaround time than either sequential or exclusionary testing, which is critically important for sick lung cancer patients to make sure they get their treatment as quickly as possible. Pennell, MD, PhD, associate professor of medicine at Cleveland Clinic, in a presscast ahead of the ASCO meeting. "Our results showed that there were substantial cost savings associated with upfront NGS testing compared to all other strategies," said lead author Nathan A. The inputs into the model included estimates of eligible patients, CMS and commercial unit costs for tests, time to test results, and rebiopsy rates. One million hypothetical newly diagnosed patients with Medicare and commercial health plans were included in the model. This study investigated the economic impact of NGS compared with sequential single-gene testing modalities to detect genomic alterations in patients with metastatic NSCLC using a decision analytic model. NGS also saved commercial insurance providers more than $250,000. Next-generation sequencing (NGS) in metastatic non-small cell lung cancer (NSCLC) can save Center for Medicare and Medicaid Services (CMS) payers $1.4 million to $2.1 million, according to a study presented at the 2018 ASCO Annual Meeting.
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