OBJECTIVES: NSCLC represents the leading cause of cancer-related mortality in Canada, with treatment predicated on genetic testing. The current Canadian genomic testing landscape for NSCLC comprises single-gene and multigene hotspot panels that examine selected regions of the genome. Comprehensive genomic profiling (CGP), a broader testing method, utilizes next-generation sequencing to detect known and novel variants across four main classes of genomic alterations. CGP may offer improved detection rates, minimizing tissue requirements and turnaround time. The objective of this analysis was to assess health and budget impact of adopting CGP for NSCLC in Canada.

METHODS: The impact of listing CGP tests, FoundationOne CDx and FoundationOne Liquid, was estimated over a three-year time horizon from a Canadian societal perspective. Conventional testing strategies were reflected in two reference scenarios: a series of single-gene tests only (Reference A), and reflex single-gene testing followed by hotspot panel for negative results (Reference B). Four adoption scenarios for CGP testing were considered with a 50% uptake: replacing all current testing modalities, replacing hotspot panel testing only, using after negative single-gene and hotspot testing, and use of only FoundationOne Liquid in individuals with insufficient tissue for conventional testing.

RESULTS: When CGP was assumed to replace all conventional testing, budget impact per-person-per-year was $0.87 in Reference A and $0.71 in Reference B, with a three-year gain of 680.9 life-years and 3,831 working days over the full cohort in both reference scenarios. When CGP use was restricted to use after negative conventional testing, the results were reduced to $0.70 in Reference A and $0.56 in Reference B, but survival and productivity benefits were reduced by over 50%.

CONCLUSIONS: Across scenarios, CGP was associated with additional life years and productivity, at an incremental cost. The health benefits of CGP increase with strategies reflecting more widespread usage.