OBJECTIVES

Treatment for mNSCLC is driven by the presence of oncogenic genomic mutations. Establishing histological subtype with tissue biopsy and identification of mutations via tissue next-generation sequencing (NGS) can guide treatment decisions. Adding Plasma NGS to Tissue NGS (Tissue NGS Reflex-to-Plasma NGS) can help in identifying appropriate patients when tissue biopsy may not be feasible. This study compares Tissue NGS Reflex-to-Plasma NGS versus Tissue NGS-Only strategies for identifying patients with mNSCLC with actionable mutations.

METHODS

Assuming a population of 1M mNSCLC patients in first-line, a decision tree estimated the clinical benefits and costs of implementing Tissue NGS Reflex-to-Plasma NGS versus Tissue NGS-Only from a payer perspective. The model included identifying patients with genomic alterations such as EGFR, ROS1, ALK, and BRAF. Testing inputs such as type of test, associated costs, number of re-biopsies and concordance were retrieved from the literature. Costs are reported in 2020 dollars. Outcomes of interest include total number of patients with actionable mutations, without actionable mutations and with unknown actionable mutation status, number of re-biopsies, and overall testing costs.

RESULTS

Out of 1M patients with mNSCLC, Tissue NGS Reflex-to-Plasma NGS found 227,342 patients with actionable mutation and 7,658 patients with unknown actionable mutation; Tissue NGS-Only found 214,177 and 20,823 respectively, resulting in 13,165 additional patients with actionable mutation. Out of 1M patients, Tissue NGS Reflex-to-Plasma NGS resulted in 17,215 re-biopsies while Tissue NGS-Only had 46,812 re-biopsies, resulting in an average testing cost per patient of $22,969 and $22,688 respectively. Sensitivity analyses showed that results are mostly sensitive to tissue availability and proportion of patients with insufficient tissue undergoing re-biopsy.

CONCLUSIONS

Implementing a Tissue NGS Reflex-to-Plasma NGS testing strategy versus Tissue NGS-Only resulted in a higher number of patients with actionable mutations identified who may benefit from targeted therapies without notable increments in testing costs.