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Cost-effectiveness Analysis of the Oncomine™ Dx Target Test MultiCDx System Using Next-generation Sequencing and
Tomomi Kohara1, Shunya Ikeda1, Koichi Benjamin Ishikawa1
1Graduate School of Public Health, International University of Health and Welfare, Tokyo, Japan.
Introduction:
To determine the appropriate treatment for patients with advanced/recurrent nonsquamous non‒small-cell lung cancer (NSCLC), a companion diagnostic was conducted to detect driver mutations through genetic testing. In Japan, Oncomine Dx Target Test (DxTT) using next-generation sequencing (NGS) that can comprehensively detect gene mutations or single-gene tests are conducted as companion diagnostics. Furthermore, cost-effectiveness analysis was conducted to compare the cost-effectiveness of Oncomine DxTT using NGS with that of single-gene test in Japan.
Methods:
The target population included patients with advanced/recurrent nonsquamous NSCLC. A model structure was constructed for the Oncomine DxTT strategy and three single-gene tests (i.e., epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1) rearrangements) with reference to previous studies and the Clinical Practice Guidelines of Lung Cancer 2022 in Japan. The model structure assumed that genetic testing would be conducted and first-line treatment used the drug most recommended in the 2022 Japanese Lung Cancer Clinical Practice Guidelines, depending on the driver mutation,. Model inputs were obtained from the literature and price list in Japan, and cost-utility analysis was conducted.
Results:
For the Oncomine DxTT strategy, the expected incremental costs and effectiveness were estimated to be approximately JPY 172,361 (JPY 12,285,228 vs. JPY 12,112,867 for strategies A and B, respectively) and -0.51 quality-adjusted life-year (QALY) per patient (21.93 QALY vs. 22.44 QALY for strategies A and B). As a result, the costs increased but the effectiveness decreased. Therefore, the Oncomine DxTT strategy was dominated by the three single-gene tests. Sensitivity and scenario analyses revealed that the test success rate of Oncomine DxTT affected the results.
Conclusions:
The genetic test using Oncomine DxTT before the first-line treatment is not cost-effective compared with the three single-gene tests (EGFR/ALK/ROS1) for patients with advanced/recurrent nonsquamous NSCLC.
Insights
The Oncomine DxTT genetic test is not cost-effective for advanced nonsquamous non-small-cell lung cancer (NSCLC) in Japan. Single-gene tests for EGFR/ALK/ROS1 are more cost-effective for guiding first-line treatment decisions.
Area of Science:
- Oncology
- Genomics
- Health Economics
Background:
- Advanced/recurrent nonsquamous non-small-cell lung cancer (NSCLC) requires targeted therapies guided by genetic driver mutations.
- Companion diagnostics, including next-generation sequencing (NGS) like Oncomine Dx Target Test (DxTT) and single-gene tests, are used in Japan for NSCLC.
- Assessing the cost-effectiveness of different diagnostic strategies is crucial for optimal healthcare resource allocation.
Purpose of the Study:
- To compare the cost-effectiveness of the Oncomine DxTT using NGS with traditional single-gene tests for patients with advanced/recurrent nonsquamous NSCLC in Japan.
- To inform treatment decisions by evaluating diagnostic strategies based on genetic mutation detection.
Main Methods:
- A cost-utility analysis was performed using a model based on Japanese Clinical Practice Guidelines for Lung Cancer (2022).
- The model compared the Oncomine DxTT strategy against three single-gene tests (EGFR mutations, ALK/ROS1 rearrangements).
- Model inputs were derived from literature and Japanese price lists; cost-effectiveness was evaluated using quality-adjusted life-years (QALYs).
Main Results:
- The Oncomine DxTT strategy was associated with higher costs (JPY 172,361 incremental) and lower effectiveness (-0.51 QALY per patient) compared to single-gene tests.
- The DxTT strategy was dominated by the single-gene test strategies, indicating it was less effective and more costly.
- Sensitivity and scenario analyses highlighted the test success rate of Oncomine DxTT as a key factor influencing the results.
Conclusions:
- The Oncomine DxTT, when used as a companion diagnostic before first-line treatment for advanced/recurrent nonsquamous NSCLC, is not cost-effective in the Japanese setting.
- Single-gene tests (EGFR/ALK/ROS1) represent a more cost-effective approach for guiding initial treatment selection in these patients.
- The findings support the use of targeted single-gene testing over comprehensive NGS panels for initial diagnostic workup in this patient population to optimize healthcare spending and patient outcomes.
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