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Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia
INTRODUCTION: Upfront next-generation sequencing (NGS) in patients with metastatic NSCLC has been associated with cost savings and shorter time-to-test results in the United States. Nevertheless, this may not apply in jurisdictions where the prevalence of patients with actionable mutations, cost of...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8919283/ https://www.ncbi.nlm.nih.gov/pubmed/35295964 http://dx.doi.org/10.1016/j.jtocrr.2022.100290 |
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author | Loong, Herbert H. Wong, Carlos K.H. Chan, Catherine P.K. Chang, Andrea Zhou, Zheng-Yi Tang, Wenxi Gibbs, Meaghan |
author_facet | Loong, Herbert H. Wong, Carlos K.H. Chan, Catherine P.K. Chang, Andrea Zhou, Zheng-Yi Tang, Wenxi Gibbs, Meaghan |
author_sort | Loong, Herbert H. |
collection | PubMed |
description | INTRODUCTION: Upfront next-generation sequencing (NGS) in patients with metastatic NSCLC has been associated with cost savings and shorter time-to-test results in the United States. Nevertheless, this may not apply in jurisdictions where the prevalence of patients with actionable mutations, cost of health care, and reimbursement models differ. METHODS: A decision analytical model was built to compare sequential, panel, exclusionary, and upfront NGS testing in patients with metastatic NSCLC in Hong Kong. In sequential and panel testing, patients were tested for genomic alterations (GAs) with treatment followed by sequential or NGS. In exclusionary testing, EGFR and ALK were tested first, followed by NGS. For each modality, the mutation identified, time to receive testing results, and costs (2020 U.S. dollars) were estimated. RESULTS: Exclusionary testing required the shortest time-to-results (1.6 wk) and was most cost saving. In the scenario where all patients used exclusionary testing, a cost saving of $4.6 million was expected relative to current practice, with 90.7% of actionable and 46.5% of nonactionable GAs detected; when all patients used NGS, it would be $2.9 million more expensive with a 100% GA detection rate. Results were sensitive to testing costs and the proportion of patients that continued testing. CONCLUSIONS: Exclusionary testing is the best option in terms of cost and time-to-results in Hong Kong. This finding may be applicable for other Asian countries; however, exclusionary testing does not capture all possible GAs. As more GAs become actionable and the cost of NGS declines, NGS may become a cost-saving option. |
format | Online Article Text |
id | pubmed-8919283 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-89192832022-03-15 Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia Loong, Herbert H. Wong, Carlos K.H. Chan, Catherine P.K. Chang, Andrea Zhou, Zheng-Yi Tang, Wenxi Gibbs, Meaghan JTO Clin Res Rep Original Article INTRODUCTION: Upfront next-generation sequencing (NGS) in patients with metastatic NSCLC has been associated with cost savings and shorter time-to-test results in the United States. Nevertheless, this may not apply in jurisdictions where the prevalence of patients with actionable mutations, cost of health care, and reimbursement models differ. METHODS: A decision analytical model was built to compare sequential, panel, exclusionary, and upfront NGS testing in patients with metastatic NSCLC in Hong Kong. In sequential and panel testing, patients were tested for genomic alterations (GAs) with treatment followed by sequential or NGS. In exclusionary testing, EGFR and ALK were tested first, followed by NGS. For each modality, the mutation identified, time to receive testing results, and costs (2020 U.S. dollars) were estimated. RESULTS: Exclusionary testing required the shortest time-to-results (1.6 wk) and was most cost saving. In the scenario where all patients used exclusionary testing, a cost saving of $4.6 million was expected relative to current practice, with 90.7% of actionable and 46.5% of nonactionable GAs detected; when all patients used NGS, it would be $2.9 million more expensive with a 100% GA detection rate. Results were sensitive to testing costs and the proportion of patients that continued testing. CONCLUSIONS: Exclusionary testing is the best option in terms of cost and time-to-results in Hong Kong. This finding may be applicable for other Asian countries; however, exclusionary testing does not capture all possible GAs. As more GAs become actionable and the cost of NGS declines, NGS may become a cost-saving option. Elsevier 2022-02-14 /pmc/articles/PMC8919283/ /pubmed/35295964 http://dx.doi.org/10.1016/j.jtocrr.2022.100290 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Loong, Herbert H. Wong, Carlos K.H. Chan, Catherine P.K. Chang, Andrea Zhou, Zheng-Yi Tang, Wenxi Gibbs, Meaghan Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia |
title | Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia |
title_full | Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia |
title_fullStr | Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia |
title_full_unstemmed | Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia |
title_short | Clinical and Economic Impact of Upfront Next-Generation Sequencing for Metastatic NSCLC in East Asia |
title_sort | clinical and economic impact of upfront next-generation sequencing for metastatic nsclc in east asia |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8919283/ https://www.ncbi.nlm.nih.gov/pubmed/35295964 http://dx.doi.org/10.1016/j.jtocrr.2022.100290 |
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