ECONOMIC EVALUATIONS OF COMPREHENSIVE GENOMIC PROFILING IN ONCOLOGY: A LITERATURE REVIEW AND PRACTICAL GUIDANCE
Author(s)
Shishi Wu, PhD1, Pattareeya Kaveepansakol, M.Sc1, Kelvin Teo, MA1, phillip kittel, M.Sc2, Kaywei Low, M.Sc3, Fabian Patrick Oliver Müller, MPH4.
1IQVIA Real World Solutions Asia-Pacific, Singapore, Singapore, 2Roche Diagnostics International Ltd, Rotkreuz, Switzerland, 3Roche Diagnostics Asia Pacific, Singapore, Singapore, 4Roche Diagnostics Asia Pacific, Bangkok, Thailand.
1IQVIA Real World Solutions Asia-Pacific, Singapore, Singapore, 2Roche Diagnostics International Ltd, Rotkreuz, Switzerland, 3Roche Diagnostics Asia Pacific, Singapore, Singapore, 4Roche Diagnostics Asia Pacific, Bangkok, Thailand.
OBJECTIVES: Comprehensive genomic profiling (CGP), an advanced next generation sequencing (NGS) approach, utilizes a single assay to capture broad genomic insights to inform tumor diagnosis, prognosis, and treatment decisions. However, reimbursement is limited across health systems, partly due to payer uncertainty regarding the value of NGS, particularly CGP. Fit-for-purpose evaluations are essential to clarify the impact of adoption with high certainty. This review synthesizes economic evidence on NGS to develop robust methodological guidance for model-based economic evaluations to support reimbursement decision-making.
METHODS: Building on a review by Mirza et al., covering studies published from 2017 to 2022, the evidence base was extended through updated searches of PubMed, Embase, and EBSCO for studies published to December 2024, supplemented by grey literature and expert recommendations. Economic evaluations were synthesized narratively, and model-based evaluations were examined for methodological details.
RESULTS: Among included studies, 23 were economic evaluations and 13 were budget impact analyses. Model-based evaluations showed significant methodological heterogeneity in structure, parameters, and cost inclusion. Across all NGS modalities, downstream drug costs exerted the highest influence on outcomes, while testing costs consistently represented a small proportion of total care costs. NGS strategies, including CGP, were more likely to demonstrate cost-effectiveness in studies that captured broader consequences i.e., testing performance, time-to-treatment, rebiopsy costs, and trial enrolment. Most economic evaluations omitted one or more of these dimensions, suggesting that conventional approaches may yield unreliable conclusions. These gaps informed development of a practical framework intended to support consistent and comprehensive parameterization in future economic evaluations.
CONCLUSIONS: Methodological heterogeneity across model-based evaluations contributes to inconsistent conclusions regarding NGS/CGP cost-effectiveness. Findings reinforce the need for better approaches capturing the full contribution of CGP, particularly, diagnostic efficiency, and identification of complex genomic signatures and ultra-rare variants. The proposed framework standardizes guidance on parameterization, supporting more transparent and decision-relevant economic evaluations for reimbursement decision-making.
METHODS: Building on a review by Mirza et al., covering studies published from 2017 to 2022, the evidence base was extended through updated searches of PubMed, Embase, and EBSCO for studies published to December 2024, supplemented by grey literature and expert recommendations. Economic evaluations were synthesized narratively, and model-based evaluations were examined for methodological details.
RESULTS: Among included studies, 23 were economic evaluations and 13 were budget impact analyses. Model-based evaluations showed significant methodological heterogeneity in structure, parameters, and cost inclusion. Across all NGS modalities, downstream drug costs exerted the highest influence on outcomes, while testing costs consistently represented a small proportion of total care costs. NGS strategies, including CGP, were more likely to demonstrate cost-effectiveness in studies that captured broader consequences i.e., testing performance, time-to-treatment, rebiopsy costs, and trial enrolment. Most economic evaluations omitted one or more of these dimensions, suggesting that conventional approaches may yield unreliable conclusions. These gaps informed development of a practical framework intended to support consistent and comprehensive parameterization in future economic evaluations.
CONCLUSIONS: Methodological heterogeneity across model-based evaluations contributes to inconsistent conclusions regarding NGS/CGP cost-effectiveness. Findings reinforce the need for better approaches capturing the full contribution of CGP, particularly, diagnostic efficiency, and identification of complex genomic signatures and ultra-rare variants. The proposed framework standardizes guidance on parameterization, supporting more transparent and decision-relevant economic evaluations for reimbursement decision-making.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HTA21
Topic
Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
SDC: Oncology