Health and Budget Impact of Liquid Biopsy (LBx)-Based Comprehensive Genomic Profiling (CGP) in Patients With Tissue-Limited Advanced Non-Small Cell Lung Cancer (aNSCLC)

OBJECTIVES: Comprehensive genomic profiling (CGP) of tissue has led to improvements in identification of actionable alterations and therapeutic selection for cancer patients. However, molecular profiling using tissue is not always feasible due to unfavorable tumor sites, invasiveness of tissue biopsies, and lengthy turnaround times. This study assessed the health and budget impact of LBx-based CGP next-generation sequencing (NGS) in patients with tissue-limited newly diagnosed non-squamous (NSQ) advanced non–small-cell lung cancer (aNSCLC) from a US commercial payer perspective.

METHODS: A decision analytic model compared two states: Standard of care (SoC) using a real-time polymerase chain reaction (RT-PCR) test which detects EGFR mutations and Future state using LBx-based CGP NGS which detects all guideline-recommended mutations. The eligible patient population was modeled using a top-down epidemiological approach based on published literature, and treatment allocation was based on biomarker prevalence and guidelines. Costs for drugs, adverse events, healthcare resource utilization, end-of-life care, and diagnostic testing were calculated.

RESULTS: In a hypothetical 1-million-member health plan, 245 members were estimated to have incident NSQ aNSCLC; 28 patients were tissue-limited. Adoption of LBx-based CGP NGS led to an increase in targeted therapy use and clinical trial enrollment while decreasing immunotherapy and/or chemotherapy use (SoC vs Future: 19.4% vs 40.1%, 0% vs 5%, 80.6% vs 54.9%, respectively). At 12 months, adoption of LBx-based CGP NGS was associated with a 3.3% increase (SoC, 67.3% vs Future, 70.6%) in overall survival, $277,815 in total cost savings, $11,064 in cost savings per tissue-insufficient patient, and $0.02 in per-member, per-month cost savings.

CONCLUSIONS: Adoption of LBx CGP NGS testing for patients with tissue-limited newly diagnosed NSQ aNSCLC was associated with improved survival and cost savings driven by the shift in utilization from immunotherapy and/or chemotherapy to targeted therapy and clinical trials.