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Next-Generation Sequencing Proves Cost-Effective in Metastatic NSCLC

May 17, 2018

An economic model comparing different types of genetic testing in metastatic non-small cell lung cancer (NSCLC) showed that next-generation sequencing (NGS) is more cost-effective than testing for one or a limited number of genes at a given time.

The economic model in its entirety will be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting (June 1-5, 2018; Chicago, IL).

Nathan A Pennell, MD, PhD, co-director, Cleveland Clinic Lung Cancer Program, and colleagues created an economic model to determine which gene testing approach is most cost-effective and time-efficient. The model utilized data from the Center for Medicare and Medicaid Services (CMS) and US commercial health plans to estimate costs. Patients with newly diagnosed metastatic NSCLC received programmed death ligand 1 (PD-L1) testing and testing for the known lung cancer-related genes (ie, EGFR, ALK, ROS1, BRAF, MET, HER2, RET, and NTRK1) using upfront NGS, sequential tests, exclusionary KRAS test and subsequent sequential tests for changes in other genes if KRAS was not mutated, or panel tests and subsequent single-gene or NGS testing for changes in other genes.

Researchers noted that upfront NGS included testing of all eight NSCLC-related genes and KRAS at once. Additionally, they acknowledged that the model accounted for the time it took to receive test results after biopsy samples were sent to the lab, costs for each type of gene testing, and the estimated number of individuals with metastatic NSCLC in the US that could be tested.

Dr Pennell and colleagues estimated that for 1 million-member health plans, 2066 tests would be paid for by CMS and 156 would be paid for by commercial payers. Furthermore, the model estimated that it would take 2 weeks for the NGS and panel results to be processed compared with 4.7 and 4.8 weeks to process the exclusionary and sequential tests, respectively.

After applying economic factors to CMS payments, researchers found that NGS testing would save about $1.4 million compared with exclusionary testing, over $1.5 million compared with sequential testing, and about $2.1 million compared with panel testing.


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For commercial payers, NGS would save $3809 compared with exclusionary testing and $250,842 compared with panel testing.

"Our results showed that there were substantial cost savings associated with upfront NGS testing compared to all other strategies," said Dr Pennell in a press release (May 16, 2018). “NGS had a faster turnaround time than either sequential or exclusionary testing, which is critically important for sick lung cancer patients to make sure they get their treatment as quickly as possible.

Authors of the study noted that further research is warranted to examine actual health systems and evaluate testing cost-efficiency in a real-world setting.—Zachary Bessette

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