OBJECTIVES

Molecular diagnostic testing options in aNSCLC include non-CGP testing (single- or multi-gene hotspot panels), and CGP (the four main classes of genomic alterations [GAs] and complex genomic biomarkers). Specific treatments are allocated based on actionable biomarkers (i.e., those listed in NCCN Clinical Practice Guidelines in Oncology [NCCN Guidelines^®], and/or with an FDA-approved drug label). This study compares the incremental benefits and costs between tissue-based CGP and non-CGP testing.

METHODS

A decision analytic model compared tissue-based CGP and non-CGP testing. Total direct, testing, and per member per month (PMPM) costs to a US commercial health plan were primary model outcomes. Secondary outcomes included number needed to test (NNT) with CGP to add 1 life-year, and NNT with CGP to treat 1 additional patient with a biomarker matched therapy. Model inputs were based on published literature (incidence rates, overall survival [OS] associated with drugs indicated for aNSCLC), administrative claims data (testing rates, biopsy rates, and conventional testing and medical service costs), CGP test pricing, and assumptions for clinical trial participation.

RESULTS

Among 2 million covered lives, an estimated 790 had aNSCLC with 74 CGP tests in the base case. Increasing CGP from 15% to 25% (+49 CGP tests) was associated with +2.7 years in population OS and a budget impact of $0.013 per PMPM. Approximately 18.5 patients would need to be tested with CGP (versus non-CGP) to add 1 life-year, and 4.8 patients would need to be tested with CGP (versus non-CGP) to put 1 individual on a biomarker-matched therapy.

CONCLUSIONS

Our model results suggest that increasing molecular diagnostic testing with CGP could help inform treatment decisions in aNSCLC patients and were associated with a gain in OS and a modest health plan budget impact, with most of the added costs attributed to increased use of effective treatments and prolonged survival.