REAL-WORLD POLICY IMPACT OF A TUMOR-AGNOSTIC CLINICAL GENE PANEL FOR ADVANCED CANCERS
Author(s)
Emanuel Krebs, MA1, Deirdre Weymann, MA1, Dean Regier, BA, MA, PhD2.
1Regulatory Science Lab, BC Cancer Research Institute, Vancouver, BC, Canada, 2School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
1Regulatory Science Lab, BC Cancer Research Institute, Vancouver, BC, Canada, 2School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
OBJECTIVES: Existing economic analyses of tumour-agnostic next generation sequencing (NGS) for advanced cancers rely on decision analytic models requiring assumptions about real-world clinical benefit and budget impact, leaving payers without population-level evidence to inform adoption decisions. British Columbia, Canada (BC) publicly reimbursed a tumour-agnostic 54-gene panel as standard care, offering a unique opportunity to quantify real-world policy impact.
METHODS: Using real-world data to emulate a pragmatic randomized trial, we considered all adult BC residents with an advanced cancer diagnosis (lung, colorectal, and melanoma) who received NGS or single-gene testing between 2016-2018 (n=3,588). We applied 1:1 genetic algorithm-based matching, a machine learning approach, to construct a contemporaneous control group. We estimated mean three-year life-years gained (LYG) and costs to conduct a budget impact analysis from a public healthcare perspective. We parameterized all cost and utilization inputs using patient-level linked administrative data. Costs (2025CAD) included those for hospitalizations, day surgeries, physician services, outpatient prescription drugs, systemic therapy and other cancer care. For BC and Canada, we calculated population- and system-level outcomes, consisting of projections over three years for the total number of patients tested, LYG, and budget impact.
RESULTS: After matching, incremental costs were $2,823 (95%CI: -$3,736-$9,256) and incremental LYG were 0.11 (95%CI: 0.00-0.19). For BC, projections resulted in 10,162 patients tested, 1,538 LYG, and a $12.1M budget impact. The largest categories were testing ($11.3M) and systemic therapy (-$2.6M). Cancer-specific budget impacts were $18.1M (lung), $15.6M (melanoma), and -$21.6M (colorectal). Canadian projections yielded 98,097 patients tested, 13,959 LYG, and a $137.8M budget impact.
CONCLUSIONS: Implementation of tumour-agnostic NGS for advanced cancers can provide meaningful survival gains at costs acceptable to health systems, with systemic therapy savings partially offsetting testing costs. These population-level, real-world estimates provide the decision-grade evidence payers and jurisdictions globally need to evaluate precision oncology adoption at scale.
METHODS: Using real-world data to emulate a pragmatic randomized trial, we considered all adult BC residents with an advanced cancer diagnosis (lung, colorectal, and melanoma) who received NGS or single-gene testing between 2016-2018 (n=3,588). We applied 1:1 genetic algorithm-based matching, a machine learning approach, to construct a contemporaneous control group. We estimated mean three-year life-years gained (LYG) and costs to conduct a budget impact analysis from a public healthcare perspective. We parameterized all cost and utilization inputs using patient-level linked administrative data. Costs (2025CAD) included those for hospitalizations, day surgeries, physician services, outpatient prescription drugs, systemic therapy and other cancer care. For BC and Canada, we calculated population- and system-level outcomes, consisting of projections over three years for the total number of patients tested, LYG, and budget impact.
RESULTS: After matching, incremental costs were $2,823 (95%CI: -$3,736-$9,256) and incremental LYG were 0.11 (95%CI: 0.00-0.19). For BC, projections resulted in 10,162 patients tested, 1,538 LYG, and a $12.1M budget impact. The largest categories were testing ($11.3M) and systemic therapy (-$2.6M). Cancer-specific budget impacts were $18.1M (lung), $15.6M (melanoma), and -$21.6M (colorectal). Canadian projections yielded 98,097 patients tested, 13,959 LYG, and a $137.8M budget impact.
CONCLUSIONS: Implementation of tumour-agnostic NGS for advanced cancers can provide meaningful survival gains at costs acceptable to health systems, with systemic therapy savings partially offsetting testing costs. These population-level, real-world estimates provide the decision-grade evidence payers and jurisdictions globally need to evaluate precision oncology adoption at scale.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR237
Topic
Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
Oncology, Personalized & Precision Medicine