Early Cost Effectiveness of Whole-Genome Sequencing as a Clinical Diagnostic Test for Patients with Inoperable Stage IIIB,C/IV Non-squamous Non-small-Cell Lung Cancer

Martijn J. H. G. Simons, Valesca P. Retèl, Bram L. T. Ramaekers, Rogier Butter, Joanne M. Mankor, Marthe S. Paats, Joachim G. J. V. Aerts, Zakile A. Mfumbilwa, Paul Roepman, Veerle M. H. Coupé, Carin A. Uyl- de Groot, Wim H. van Harten and Manuela A. Joore ()
Additional contact information
Martijn J. H. G. Simons: Maastricht University Medical Centre
Valesca P. Retèl: Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital
Bram L. T. Ramaekers: Maastricht University Medical Centre
Rogier Butter: Amsterdam University Medical Center, University of Amsterdam
Joanne M. Mankor: Erasmus Medical Centre
Marthe S. Paats: Erasmus Medical Centre
Joachim G. J. V. Aerts: Erasmus Medical Centre
Zakile A. Mfumbilwa: Amsterdam University Medical Center-Location VUmc
Paul Roepman: Hartwig Medical Foundation
Veerle M. H. Coupé: Amsterdam University Medical Center-Location VUmc
Carin A. Uyl- de Groot: Erasmus University Rotterdam
Wim H. van Harten: Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital
Manuela A. Joore: Maastricht University Medical Centre

PharmacoEconomics, 2021, vol. 39, issue 12, No 7, 1429-1442

Abstract: Abstract Background Advanced non-small-cell lung cancer (NSCLC) harbours many genetic aberrations that can be targeted with systemic treatments. Whole-genome sequencing (WGS) can simultaneously detect these (and possibly new) molecular targets. However, the exact added clinical value of WGS is unknown. Objective The objective of this study was to determine the early cost effectiveness of using WGS in diagnostic strategies compared with currently used molecular diagnostics for patients with inoperable stage IIIB,C/IV non-squamous NSCLC from a Dutch healthcare perspective. Methods A decision tree represented the diagnostic pathway, and a cohort state transition model represented disease progression. Three diagnostic strategies were modelled: standard of care (SoC) alone, WGS as a diagnostic test, and SoC followed by WGS. Treatment effectiveness was based on a systematic review. Probabilistic cost-effectiveness analyses were performed, and threshold analyses (using €80,000 per quality-adjusted life-year [QALY]) was used to explore the early cost effectiveness of WGS. Results WGS as a diagnostic test resulted in more QALYs (0.002) and costs (€1534 [incremental net monetary benefit –€1349]), and SoC followed by WGS resulted in fewer QALYs (–0.002) and more costs (€1059 [–€1194]) compared with SoC alone. WGS as a diagnostic test was only cost effective if it was priced at €2000 per patient and identified 2.7% more actionable patients than SoC alone. Treating these additional identified patients with new treatments costing >€4069 per month decreased the probability of cost effectiveness. Conclusions Our analysis suggests that providing WGS as a diagnostic test is cost effective compared with SoC followed by WGS and SoC alone if costs for WGS decrease and additional patients with actionable targets are identified. This cost-effectiveness model can be used to incorporate new findings iteratively and to support ongoing decision making regarding the use of WGS in this rapidly evolving field.

Date: 2021
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DOI: 10.1007/s40273-021-01073-y

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