The Clinical and Economic Impact of Nationwide Insurance Coverage for Next-Generation Sequencing in Advanced Ovarian Cancer: A Retrospective Observational Study Using the Nationwide Database in South Korea

OBJECTIVES: Next-generation sequencing (NGS) has been covered by Korean national health insurance since March 2017 for patients with cancer. This study compared the clinical and economic impact of NGS with that of single gene tests (SGTs).

METHODS: We included patients diagnosed with advanced ovarian cancer between March 1, 2017, and December 31, 2018, from the Korea Central Cancer Registry and the Health Insurance Review and Assessment database. Advanced disease was identified using the Summary Stage. Only patients who had NGS or SGT within 2 months of diagnosis were included to minimize guarantee-time bias. Using multivariate logistic regression with covariates including age, sex, Charlson comorbidity index, insurance type, year of diagnosis, and region and type of hospital with the initial diagnosis, 1:2 propensity score matching was conducted. The adjusted hazard ratio for death from the Cox proportional hazard model was compared between the two cohorts. Estimated total medical costs were provided for each group.

RESULTS: Among 504 patients with advanced ovarian cancer, 168 patients were identified as NGS group and 336 as SGT group after matching. There were no covariates significantly different between NGS and SGT groups. The risk for death between the two groups was not significantly different (aHR: 0.95, 95% confidence interval: 0.54 – 1.67, P =.863). The total medical cost was higher in the NGS group ($51,203) compared to the SGT group ($43,020).

CONCLUSIONS: NGS was not associated with a reduction in the risk of death, but rather increased the economic burden compared to SGT alone in patients with advanced ovarian cancer. Providing NGS at a lower cost may not be an effective strategy in implementing precision oncology in patients with ovarian cancer.