Impact on costs and outcomes of multi-gene panel testing for advanced solid malignancies: a cost-consequence analysis...

Area of Science:

• Oncology
• Genomics
• Health Economics

Background:

• Economic analyses of tissue-based next-generation sequencing (NGS) genomic profiling for advanced solid tumors often rely on models with assumptions.
• Real-world evidence on overall survival (OS), clinical trial enrollment, and end-of-life care quality is limited.

Purpose of the Study:

• To conduct a cost-consequence analysis of NGS testing using the OCTANE clinical trial data.
• To evaluate the real-world impact of NGS on healthcare costs, OS, clinical trial enrollment, and end-of-life care.

Main Methods:

• A retrospective cohort study in Ontario, Canada, propensity score-matched 782 OCTANE patients with 782 controls.
• Linked administrative data were used to analyze costs, OS, clinical trial enrollment, and end-of-life quality metrics over a 2-year follow-up.
• Sensitivity analyses were performed on alternative matched cohorts.

Main Results:

• OCTANE patients had higher mean healthcare costs ($79,702 vs. $59,550), but lower publicly funded drug costs ($20,015 vs. $24,465).
• NGS testing was not associated with improved OS overall (1.50 vs. 1.44 years), but showed improvements in ovarian and biliary cancers.
• OCTANE was linked to higher clinical trial enrollment (25.4% vs. 9.5%) and better end-of-life care (fewer in-hospital deaths).

Conclusions:

• Multi-gene panel testing for advanced cancers increases healthcare costs but does not significantly improve overall survival across all tumor types.
• NGS testing is associated with increased clinical trial enrollment, reduced publicly funded drug costs, and improved end-of-life care quality.
• These findings highlight important considerations for determining the value of NGS panel testing in advanced cancer care.