Cost-Consequence and Clinical Impact of NGS Testing in Advanced Lung Adenocarcinoma: Real-World Evidence From a Portuguese Public Hospital
Author(s)
Maria Gabriela O. Fernandes, MD, PhD1, Ana Sofia Silva, MSc2, Tomás Oliveira, MSc2, Joana Sousa, MSc2, Carolina Valente, MD, MSc3, Conceição Moura, MD3, Sandra Relvas, MSc3, Luís Cirnes, MSc4, José Carlos Machado, PhD5, Joana Ferreira, MD, MSc3, Mariana Cascais, MD, MSc3, Mariana Ganhão, BSc3, José Mariano, MSc6, Susana Ferreira Santos, PharmD6, João Carvalho, PhD6, Patrícia Redondo, MSc2.
1ULS São João, Faculty of Medicine, University of Porto, IPATIMUP/i3s, Porto, Portugal, 2MOAI Consulting, Lisboa, Portugal, 3ULS São João, Porto, Portugal, 4IPATIMUP, School of Health, Polytechnic Institute of Porto, Porto, Portugal, 5IPATIMUP, Faculty of Medicine, University of Porto, Porto, Portugal, 6J&J Innovative Medicine, Lisboa, Portugal.
1ULS São João, Faculty of Medicine, University of Porto, IPATIMUP/i3s, Porto, Portugal, 2MOAI Consulting, Lisboa, Portugal, 3ULS São João, Porto, Portugal, 4IPATIMUP, School of Health, Polytechnic Institute of Porto, Porto, Portugal, 5IPATIMUP, Faculty of Medicine, University of Porto, Porto, Portugal, 6J&J Innovative Medicine, Lisboa, Portugal.
OBJECTIVES: Despite advances in precision oncology, the adoption of Next Generation Sequencing (NGS) remains limited, often due to cost concerns. This study aimed to assess the cost-consequence and clinical impact of implementing reflex NGS testing at diagnosis for advanced lung adenocarcinoma patients at a northern public hospital in Portugal.
METHODS: A retrospective, unicentric, observational study was conducted comparing two cohorts: patients tested with single-gene methods (EGFR/ALK by Sanger/FISH) between 2015-2016 (n=117), and those tested via reflex NGS (52-gene panel) between 2021-2022 (n=200). Process mapping, time-driven activity-based costing (TDABC), and statistical analysis (RStudio; p<0.05) were used to evaluate resource utilization, mutation detection, and cost-consequence.
RESULTS: NGS significantly increased mutation detection (70.0% vs. 26.5%) and doubled the proportion of patients with actionable mutations for first-line treatment (36.0% vs. 18.8%). Among those actionable by NGS, 58.3% received a tyrosine kinase inhibitor (TKI) as 1st-line therapy. NGS also identified actionable alterations for any treatment line in 93.1% of mutated patients. Although the per-test cost of NGS was higher (€532.85 vs. €384.35), the cost per actionable mutation identified was 36% lower than Sanger and 72% lower than FISH, thus enabling the identification of more treatable mutations with less investment per clinically useful result. Furthermore, it reduced test failure rates (18% with sequential testing) by minimizing sample exhaustion. Compared to multi-gene sequential strategies, NGS becomes more cost-effective when three or more tests are required.
CONCLUSIONS: Reflex NGS testing at diagnosis enables broader genomic profiling, identifies more actionable mutations, and supports timely initiation of targeted therapies, potentially improving clinical outcomes. Although the upfront cost is higher, NGS proves more efficient, cost-effective, and clinically advantageous than conventional or sequential testing. These findings support broader implementation of reflex NGS to promote timely, equitable precision oncology in public health systems.
METHODS: A retrospective, unicentric, observational study was conducted comparing two cohorts: patients tested with single-gene methods (EGFR/ALK by Sanger/FISH) between 2015-2016 (n=117), and those tested via reflex NGS (52-gene panel) between 2021-2022 (n=200). Process mapping, time-driven activity-based costing (TDABC), and statistical analysis (RStudio; p<0.05) were used to evaluate resource utilization, mutation detection, and cost-consequence.
RESULTS: NGS significantly increased mutation detection (70.0% vs. 26.5%) and doubled the proportion of patients with actionable mutations for first-line treatment (36.0% vs. 18.8%). Among those actionable by NGS, 58.3% received a tyrosine kinase inhibitor (TKI) as 1st-line therapy. NGS also identified actionable alterations for any treatment line in 93.1% of mutated patients. Although the per-test cost of NGS was higher (€532.85 vs. €384.35), the cost per actionable mutation identified was 36% lower than Sanger and 72% lower than FISH, thus enabling the identification of more treatable mutations with less investment per clinically useful result. Furthermore, it reduced test failure rates (18% with sequential testing) by minimizing sample exhaustion. Compared to multi-gene sequential strategies, NGS becomes more cost-effective when three or more tests are required.
CONCLUSIONS: Reflex NGS testing at diagnosis enables broader genomic profiling, identifies more actionable mutations, and supports timely initiation of targeted therapies, potentially improving clinical outcomes. Although the upfront cost is higher, NGS proves more efficient, cost-effective, and clinically advantageous than conventional or sequential testing. These findings support broader implementation of reflex NGS to promote timely, equitable precision oncology in public health systems.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE192
Topic
Clinical Outcomes, Economic Evaluation, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Personalized & Precision Medicine