A model comparing the value of broad next-gen sequencing (NGS)-based testing to single gene testing (SGT) in patients with nonsquamous non-small cell lung cancer (NSCLC) in the United States.

Abstract

9529 Background: Patients (pts) with nonsquamous (ns) NSCLC should be tested for actionable driver oncogenes (ADOs), and highly effective treatments (tx) may be available for these pts. Although EGFR and ALK single gene testing (SGT) is relatively common (>80%) in the US, testing for less common ADOs is rare. Unidentified pts with ADOs have survival comparable to pts without alterations. We interrogate plausible testing configurations and discuss their implications for the US population. Methods: Simulation was used to evaluate various levels of testing with SGT or NGS on the basis of life years gained (LYG) as well as cost per LYG. Expected prevalence of ADOs among nsNSCLC pts as well as the survival distribution of pts in the presence versus absence of an ADO tx strategy were calibrated based on current literature. Survival duration for each simulated pt was generated from Weibull distributions fit to statistical estimates of median and 5-year survival. With appropriate match between ADO and targeted tx, the Weibull distribution offered a median additional 2 years of life. ADOs included in NGS: EGFR, ALK, ROS1, BRAF, RET, MET, NTRK. SGT: EGFR and ALK. Results: Each incremental 10% increase in NGS instead of SGT produces 2630 additional LYG and a cost savings per LYG between -$49 to -$109. At the current 80% testing rate, replacing SGT with NGS would result in an additional 21,019 LYG with reduced cost per LYG of -$599. Increasing testing from 80% to 100% of eligible pts would increase LYG by 15,017 over the current state. If 100% of eligible pts were tested with NGS and every identified pt received tx, the cost per LYG of this strategy would be $16,641.57. Conclusions: In a hypothetical model where highly effective tx is available to all identified pts with ADOs, broad NGS testing compared to SGT for EGFR/ALK leads to large gains in life years at reduced cost per LYG compared to SGT, supporting universal NGS testing of all advanced nsNSCLC pts. Conversely, lower levels of testing or only testing for common ADOs (as is the current state) result in large numbers of pts being unidentified and not experiencing these benefits. [Table: see text]