Next-Generation Sequencing in Clinical Practice: Is It a Cost-Saving Alternative to a Single-Gene Testing Approach?

Giancarlo Pruneri, Filippo Braud, Anna Sapino, Massimo Aglietta, Andrea Vecchione, Raffaele Giusti, Caterina Marchiò, Stefania Scarpino, Anna Baggi, Giuseppe Bonetti, Jean Marie Franzini, Marco Volpe and Claudio Jommi ()
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Giancarlo Pruneri: Fondazione IRCCS-Istituto Nazionale dei Tumori
Filippo Braud: Fondazione IRCCS-Istituto Nazionale dei Tumori
Anna Sapino: Candiolo Cancer Institute-FPO-IRCCS-Candiolo
Massimo Aglietta: Candiolo Cancer Institute-FPO-IRCCS-Candiolo
Andrea Vecchione: University of Rome La Sapienza
Raffaele Giusti: St. Andrea University Hospital
Caterina Marchiò: Candiolo Cancer Institute-FPO-IRCCS-Candiolo
Stefania Scarpino: University of Rome La Sapienza
Anna Baggi: Business Integration Partners
Giuseppe Bonetti: Business Integration Partners
Jean Marie Franzini: Business Integration Partners
Marco Volpe: Business Integration Partners
Claudio Jommi: Bocconi University

PharmacoEconomics - Open, 2021, vol. 5, issue 2, No 14, 285-298

Abstract: Abstract Objectives This study aimed to compare the costs of a next-generation sequencing-based (NGS-based) panel testing strategy to those of a single-gene testing-based (SGT-based) strategy, considering different scenarios of clinical practice evolution. Methods Three Italian hospitals were analysed, and four different testing pathways (paths 1, 2, 3, and 4) were identified: two for advanced non-small-cell lung cancer (aNSCLC) patients and two for unresectable metastatic colon-rectal cancer (mCRC) patients. For each path, we explored four scenarios considering the current clinical practice and its expected evolution. The 16 testing cases (4 scenarios × 4 paths) were then compared in terms of differential costs between the NGS-based and SGT-based approaches considering personnel, consumables, equipment, and overhead costs. Break-even and sensitivity analyses were performed. Data gathering, aimed at identifying the hospital setup, was performed through a semi-structured questionnaire administered to the professionals involved in testing activities. Results The NGS-based strategy was found to be a cost-saving alternative to the SGT-based strategy in 15 of the 16 testing cases. The break-even threshold, the minimum number of patients required to make the NGS-based approach less costly than the SGT-based approach, varied across the testing cases depending on molecular alterations tested, techniques adopted, and specific costs. The analysis found the NGS-based approach to be less costly than the SGT-based approach in nine of the 16 testing cases at any volume of tests performed; in six cases, the NGS-based approach was found to be less costly above a threshold (and in one case, it was found to be always more expensive). Savings obtained using an NGS-based approach ranged from €30 to €1249 per patient; in the unique testing case where NGS was more costly, the additional cost per patient was €25. Conclusions An NGS-based approach may be less costly than an SGT-based approach; also, generated savings increase with the number of patients and different molecular alterations tested.

Date: 2021
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DOI: 10.1007/s41669-020-00249-0

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