The Economic Impact of Early Comprehensive Genomic Profiling and Targeted Therapy for Advanced Non-Small Cell Lung Cancer Patients: Real World Evidence From a Brazilian Private Healthcare Provider Database

OBJECTIVES: The incidence and mortality of advanced Non-Small Cell Lung Cancer (NSCLC) have been rising annually in Brazil. Comprehensive Genomic Profiling (CGP) is recommended in the main international oncology guidelines to improve progression-free survival and quality of life by guiding patients to targeted therapies. However, due to cost uncertainties, CGP testing is not reimbursed by the private healthcare system, leading to delays in testing through alternative funding mechanisms. This often results in patients receiving conventional chemotherapy unnecessarily until CGP results are available, incurring avoidable costs. This study aimed to assess the financial impact of delayed CGP testing on the treatment journey of NSCLC patients within a private healthcare insurance provider in Rio Grande do Sul state, Brazil.

METHODS: The anonymized data from stage III and IV Lung adenocarcinoma patients receiving targeted therapy registered between 2019 and 2022 in the Healthcare provider database was identified from which the procedures, therapies, costs and dates were extracted and compared.

RESULTS: Retrospective analysis of patient data identified 25 cases of lung cancer, of which 8 met the criteria for inclusion. Among these, 5 patients underwent a typical treatment pathway, starting targeted therapy from the first cycle. However, due to delays in CGP testing, 3 patients received 1 or 2 cycles of conventional chemotherapy before starting targeted therapy. This delay resulted in an incremental cost of R$ 81,751.00 in total, averaging R$ 27,250.40 per patient.

CONCLUSIONS: For these 3 patients, there was no toxicity report to justify the transition to targeted therapy, the conventional therapy was used prior the CGP test results, once the CGP test result was available the therapeutic approach was changed. Early CGP testing not only optimizes treatment pathways by directly guiding patients to targeted therapies but also reduces healthcare expenditures associated with unnecessary chemotherapy cycles.