Economic Evaluation of Comprehensive Genomic Profiling in an Advanced Solid Cancer Population

Abstract

QuestionWhat are the health economic consequences of comprehensive genomic profiling (CGP) in an advanced pancancer population?FindingsThis economic evaluation with 814 participants found that diagnostic costs amount to <euro>2816 to identify 1 patient with an actionable target to <euro>14 249 to identify 1 patient receiving a CGP-matched treatment. Adopting a conceptual willingness-to-pay threshold of <euro>5000 per matched treatment, a CGP cost reduction to <euro>1250 combined with an increased uptake of molecular tumor board recommendations to 47% was required to achieve a positive net monetary benefit.MeaningThese results suggest that substantial diagnostic costs made to match 1 CGP-informed treatment can be reduced most effectively by lowering diagnostic costs and increasing uptake of molecular tumor board recommendations. This economic evaluation of patients with advanced cancer addresses some of the challenges of conducting a full cost-effectiveness analysis of comprehensive genomic profiling and provides insights into the associated benefits and costs of comprehensive genomic profiling alongside the diagnostic pathway. ImportanceDevelopments in genomic profiling introduced larger gene panels with decreasing sequencing costs. Although the feasibility of comprehensive genomic profiling (CGP) has been demonstrated, its health economic impact remains uncertain.ObjectiveTo provide insights into the costs related to clinical implementation of CGP-based advice in a large prospective cohort.Design, Setting, and ParticipantsIn this economic evaluation of a prospective Belgian multicenter observational study (Belgian Approach of Local Laboratory Extensive Tumor Testing [BALLETT]), a decision tree was designed to illustrate costs and outcomes adopting a diagnostic time horizon. The evaluation also included a future evaluation scenario comparing standard-of-care diagnostics with upfront CGP. This study included patients with advanced solid tumors enrolled in the BALLETT study between May 1, 2021, and October 31, 2023. Analyses were conducted using the entire study population and individual tumor types.ExposureCGP followed by molecular tumor board (MTB) discussions to formulate treatment recommendations.Main Outcomes and MeasuresModel outcomes were total diagnostic costs and the percentage of patients with actionable targets, MTB recommendations, and matched treatments. Incremental cost-consequence ratios were calculated.ResultsA total of 814 patients with advanced tumors (mean [SD] age, 60.8 [12.3] years; 452 female [55.5%]) participated in the study. The mean diagnostic costs for patients of the BALLETT cohort were <euro>2147. Actionable targets were identified in 621 patients (76%), MTB recommendations were provided in 529 patients (65%), and 123 patients (15%) received a matched treatment. The diagnostic cost to match a CGP-matched treatment was <euro>14 249. This cost varied between specific tumor types (<euro>9952 for lung cancer to <euro>20 377 for colon cancer). Sensitivity analyses showed that these cost-consequence ratios are most influenced by diagnostic cost and the uptake of MTB recommendations. In the scenario comparing upfront CGP and standard-of-care diagnostics, the incremental diagnostic cost to match a treatment was estimated to be slightly lower (<euro>13 936).Conclusions and RelevanceThis economic evaluation of CGP in patients with advanced cancer estimated the diagnostic cost to match a treatment. CGP-matched treatment cost and benefit requirements were estimated under which CGP was cost-effective, thereby providing health care decision-makers with relevant economic evidence for decision-making.