OBJECTIVES: Next generation sequencing (NGS) is used to identify genetic markers of disease, making it important for personalized cancer treatment. NGS testing can occur in external laboratories (send-out) or in the hospital (in-house). We analyzed the impact on hospital budgets if they invested in increased in-house testing for metastatic non-small lung cancer (mNSCLC).

METHODS: A cohort-level, decision-tree model feeding into a Markov model was used to compare two hospital pathways: only send-out versus mixed in-house (75%) and send-out (25%) (mixed). A time horizon of five years was considered from the perspective of a US hospital. The key model inputs were derived from a retrospective analysis of real-world data of newly diagnosed stage IV mNSCLC cases and all others from expert opinions and peer-reviewed articles. Costs are in 2021 USD, including costs of NGS capital acquisition.

RESULTS: For a hospital with 500 mNSCLC cases per year, the model estimated increases in overall testing costs as well as revenue with the use of the mixed approach. Compared to send-out, the mixed approach resulted in $710,060 of increased testing costs and $1,732, 506.31 of increased revenue over the five-year time horizon. The net benefit was $1,022,446 (95% credible Interval, $787,903; 1,252,846) with a positive break-even point after 15 (14; 17) months of investment. The mixed approach reduced the mean test turnaround time by 9.86 (9.21; 10.49) days and led to a +3.38 (2.31; 4.05) %-points increase (send-out 10.35%, mixed approach 13.73%) in patients on targeted therapies.

CONCLUSIONS: An in-house NGS system could be profitable for a hospital, reduce the testing turnaround time, and increase the proportion of mNSCLC patients on targeted therapy.