Evaluating the Cost of Genomic Testing for Biomarker-Driven Therapies in Oncology

Genomic profiling is used in the diagnosis, monitoring, and treatment of malignancies. Comprehensive genomic profiling (CGP) is a next-generation sequencing (NGS) approach that can test multiple genes simultaneously, potentially saving time, money, and sample material. Costs associated with genomic profiling could be a prohibitive barrier to the widespread implementation of genomic testing in routine clinical practice.

A cost calculator was developed to demonstrate the cost difference between targeted panel NGS and individual single-gene testing (SGT). The calculator evaluates the cost of testing for more than 30 biomarkers included in the 2024 update of the European Society for Medical Oncology (ESMO) Scale for Clinical Actionability of Molecular Targets. Sensitivity and specificity data for NGS and SGT, biomarker prevalence, and the number needed to predict (NNP) metric were used to estimate the cost of each test per correctly identified patient (CCIP) in different types of tumors. Calculator results are available in EUR (€) and USD ($), inflated to 2025 values. The calculator generates results for 14 different advanced malignancies.

At base case in EUR (€), CCIP was lower with NGS than sequential SGT for metastatic colorectal cancer (mCRC), advanced prostate cancer, advanced pancreatic ductal adenocarcinoma (PDAC), advanced cholangiocarcinoma (CC), advanced soft-tissue sarcoma (STS), advanced thyroid cancer, and cancer of unknown primary origin (CUP). In USD ($) all of the aforementioned tumors except for advanced CC had more favorable CCIPs for NGS, compared with sequential SGT.

The insights provided by this calculator demonstrate lower costs using NGS compared with SGT for many malignancies, which suggests that opportunities exist for the expanded use of NGS in routine clinical practice for molecular profiling of patients with cancer.