Real-world cost-effectiveness of multi-gene panel sequencing to inform therapeutic decisions for advanced non-small cell lung cancer: a population-based study

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2024-11-15 DOI:10.1016/j.lana.2024.100936

Emanuel Krebs , Deirdre Weymann , Cheryl Ho , Ian Bosdet , Janessa Laskin , Howard J. Lim , Stephen Yip , Aly Karsan , Timothy P. Hanna , Samantha Pollard , Dean A. Regier

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Abstract

Background

Multi-gene panel sequencing streamlines treatment selection for advanced non-small cell lung cancer (NSCLC). Implementation continues to be uneven across jurisdictions, partly due to uncertain clinical and economic impacts. In British Columbia (BC), Canada, the public healthcare system reimbursed a multi-gene panel in September 2016. This study determined the population-level cost-effectiveness of publicly reimbursed multi-gene panel sequencing compared to single-gene testing for advanced NSCLC.

Methods

Our population-based retrospective study design used patient-level linked administrative health databases. We considered adult BC residents with a panel-eligible lung cancer diagnosis between September 2016 and December 2018. Using a machine learning approach, we conducted 1:1 genetic algorithm matching of recipients receiving multi-gene panel sequencing to controls receiving single-gene testing, maximising balance on observed demographic and clinical characteristics. Following matching, we estimated mean three-year survival time and costs (public healthcare payer perspective; 2021 CAD) and calculated the incremental net monetary benefit (INMB) for life-years gained (LYG) at conventional willingness-to-pay thresholds using inverse probability of censoring weighted linear regression and nonparametric bootstrapping.

Findings

We matched 858 panel-eligible advanced NSCLC patients to controls, achieving balance for the 16 included covariates. Average test turnaround times were 18.6 days for multi-gene panel sequencing and 7.0 days for single-gene testing. After matching, mean incremental costs were $3529 (95% CI: −$4268, $10,942) and mean incremental LYG were 0.08 (95% CI: −0.04, 0.18). Among the 1000 bootstrap samples, 14.5% had lower costs and increased survival and 78.6% had higher costs and increased survival. The INMB was $523 (95% CI: −$6256, $7023) at $50,000/LYG, with a 57.5% probability of being cost-effective, and $4575 (95% CI: −$5468, $14,064) at $100,000/LYG, with an 84.0% probability of being cost-effective.

Interpretation

Using population-based real-world data, we found a moderate to high probability that panel-based testing to inform targeted treatment for NSCLC would be cost-effective at higher thresholds.

Funding

This research was supported by Genome British Columbia/Genome Canada (G05CHS) and the Terry Fox Research Institute.

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为晚期非小细胞肺癌治疗决策提供信息的多基因组测序的实际成本效益：一项基于人群的研究

背景多基因组测序简化了晚期非小细胞肺癌（NSCLC）的治疗选择。各辖区的实施情况仍然参差不齐，部分原因是临床和经济影响不确定。在加拿大不列颠哥伦比亚省（BC），公共医疗系统于2016年9月对多基因面板进行了报销。本研究确定了与晚期NSCLC单基因检测相比，公共报销的多基因面板测序在人群层面的成本效益。方法我们基于人群的回顾性研究设计使用了患者层面的关联行政健康数据库。我们考虑了在 2016 年 9 月至 2018 年 12 月期间诊断出符合面板条件的肺癌的不列颠哥伦比亚省成年居民。利用机器学习方法，我们将接受多基因面板测序的受试者与接受单基因检测的对照者进行了1:1遗传算法匹配，最大限度地平衡了观察到的人口统计学和临床特征。匹配后，我们估算了平均三年生存时间和成本（公共医疗支付方视角；2021 CAD），并使用反概率删减加权线性回归和非参数引导法计算了在传统支付意愿阈值下获得的生命年数（LYG）的增量净货币效益（INMB）。多基因组测序的平均测试周转时间为 18.6 天，单基因测试为 7.0 天。匹配后，平均增量成本为 3529 美元（95% CI：-4268 美元，10942 美元），平均增量 LYG 为 0.08（95% CI：-0.04，0.18）。在 1000 个自举样本中，14.5% 的样本成本较低而生存率提高，78.6% 的样本成本较高而生存率提高。INMB为523美元（95% CI：-6256美元，7023美元），按50000美元/LYG计算，具有成本效益的概率为57.5%；按100000美元/LYG计算，INMB为4575美元（95% CI：-5468美元，14064美元），具有成本效益的概率为84.0%。解释利用基于人群的真实世界数据，我们发现在较高的阈值下，为NSCLC靶向治疗提供信息的基于面板的检测具有中到高的成本效益。

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

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0.00%

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期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.