COST-EFFECTIVENESS OF PRE-TREATMENT COMPREHENSIVE GENOMIC PROFILING IN ADVANCED NON-SMALL-CELL LUNG CANCER: A JAPANESE PAYER PERSPECTIVE
Author(s)
Ataru Igarashi, PhD1, Ayako Shoji, PhD2, Shizuko Suzuki, MS3.
1Professor, Graduate School of Business Administration, Keio University, Yokohama, Japan, 2University of Tokyo, Bunkyo-ku, Japan, 3Illumina KK, Tokyo, Japan.
1Professor, Graduate School of Business Administration, Keio University, Yokohama, Japan, 2University of Tokyo, Bunkyo-ku, Japan, 3Illumina KK, Tokyo, Japan.
OBJECTIVES: To assess the cost-effectiveness of comprehensive genomic profiling (CGP) performed prior to first-line therapy versus after standard treatment in patients with unresectable advanced or recurrent non-small-cell lung cancer (NSCLC) in Japan.
METHODS: A hybrid decision-tree and partitioned survival model was developed from the Japanese public healthcare payer perspective. The intervention was pre-treatment CGP; the comparator was Oncomine Dx Target Test (DxTT)-guided therapy followed by post-progression CGP, reflecting current clinical practice. Eleven mutation-directed regimens (EGFR, ALK, ROS1, BRAF, HER2, KRAS, RET, NTRK, METex14) and PD-L1-stratified regimens for wild-type patients were modelled per the Japanese Lung Cancer Guidelines 2024. Test costs were JPY 560,000 (CGP) and JPY 180,000 (DxTT). Utilities were 0.710 (progression-free) and 0.670 (progressed). Costs and QALYs were discounted at 2% annually with a one-month cycle. Deterministic and probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to JPY 5.0 million to 7.5 million/QALY.
RESULTS: Pre-treatment CGP yielded 2.376 QALYs at JPY 17,361,182, versus 2.308 QALYs at JPY 15,302,900 with post-treatment CGP. Incremental cost and effectiveness were JPY 2,058,281 and 0.068 QALYs, respectively, producing an ICER of JPY 30,374,486/QALY (~USD 200,000/QALY)—approximately four-to-six fold above to oncology threshold. Sensitivity analyses identified targeted-agent pricing, immune checkpoint inhibitor (ICI) efficacy, and DxTT missing rate as principal drivers. The ICER remained above JPY 15 million/QALY across all plausible scenarios, and reductions in CGP unit cost alone did not yield cost-effectiveness.
CONCLUSIONS: Pre-treatment CGP confers modest QALY gains but is unlikely to be cost-effective under current Japanese drug pricing. Its economic value is determined less by the test itself than by the price and efficacy of downstream targeted therapies and ICIs, indicating that CGP should be appraised within the broader precision-oncology ecosystem rather than as a standalone diagnostic.
METHODS: A hybrid decision-tree and partitioned survival model was developed from the Japanese public healthcare payer perspective. The intervention was pre-treatment CGP; the comparator was Oncomine Dx Target Test (DxTT)-guided therapy followed by post-progression CGP, reflecting current clinical practice. Eleven mutation-directed regimens (EGFR, ALK, ROS1, BRAF, HER2, KRAS, RET, NTRK, METex14) and PD-L1-stratified regimens for wild-type patients were modelled per the Japanese Lung Cancer Guidelines 2024. Test costs were JPY 560,000 (CGP) and JPY 180,000 (DxTT). Utilities were 0.710 (progression-free) and 0.670 (progressed). Costs and QALYs were discounted at 2% annually with a one-month cycle. Deterministic and probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to JPY 5.0 million to 7.5 million/QALY.
RESULTS: Pre-treatment CGP yielded 2.376 QALYs at JPY 17,361,182, versus 2.308 QALYs at JPY 15,302,900 with post-treatment CGP. Incremental cost and effectiveness were JPY 2,058,281 and 0.068 QALYs, respectively, producing an ICER of JPY 30,374,486/QALY (~USD 200,000/QALY)—approximately four-to-six fold above to oncology threshold. Sensitivity analyses identified targeted-agent pricing, immune checkpoint inhibitor (ICI) efficacy, and DxTT missing rate as principal drivers. The ICER remained above JPY 15 million/QALY across all plausible scenarios, and reductions in CGP unit cost alone did not yield cost-effectiveness.
CONCLUSIONS: Pre-treatment CGP confers modest QALY gains but is unlikely to be cost-effective under current Japanese drug pricing. Its economic value is determined less by the test itself than by the price and efficacy of downstream targeted therapies and ICIs, indicating that CGP should be appraised within the broader precision-oncology ecosystem rather than as a standalone diagnostic.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE676
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Disease
Oncology