Switching to NGS would lead to more targeted NSCLC care, but may not reduce costs

Switching to NGS would lead to more targeted NSCLC care, but may not reduce costs

The study, based on care in Japan, found that patients would be more quickly referred for targeted therapy.

Adopting next-generation sequencing (NGS) instead of sequential single gene testing (SSG) would likely result in a small increase in future costs for diagnosing and treating patients with advanced non-small cell lung cancer (NSCLC) , but the change also allows for faster initiation of therapy and more targeted treatments, according to a new study from Japan.

Lung cancer is the most common cause of cancer-related morbidity and mortality among Japanese people, noted corresponding author Toru Ogawa, MD, of Bayer Yakuhin, Ltd., and colleagues. In cases of NSCLC, identifying genetic mutations can allow doctors to take advantage of targeted therapies that improve outcomes.

There are currently 2 methods to identify these mutations: NGS and SSG. SSG involves testing for single mutations in order of prevalence, but this takes longer and often requires multiple biopsies, the authors noted. NGS is newer, requires smaller tissue samples, and can test multiple mutations simultaneously.

“Therefore, NGS allows for faster initiation of targeted therapy in patients with aNSCLC than SSG, facilitating improved treatment outcomes and increased survival rates,” they wrote. .

Still, NGS is only available in limited settings in Japan, and the authors said many healthcare providers are unaware of its benefits.

Ogawa and his colleagues wanted to see what impact an expansion of NGS might have on overall health care expenditures (biopsy, tests, and treatment) on patients with advanced NSCLC. They decided to use a budget impact model and compare the costs of the current SSG system to the one in which NGS was used instead.

Currently, although NGS can simultaneously test for various genetic alterations, patients who test positive for MEET and NTRK mutations are retested using approved diagnostic tests to confirm the results, the authors said. This is because NGS results have not yet been approved in Japan for diagnosis, but only for research purposes.

Due to the current limitations of NGS, the authors performed 2 types of comparisons. The first compared SSG to the current paradigm, in which NGS results require retesting (current NGS). The second analysis compared SSG to the costs that would be associated with NGS in the future, when the authors assumed that a new test would not be needed (future NGS). The analysis was based on healthcare costs in Japan.

Projections showed that replacing SSG with NGS under current protocols would result in a slight reduction in healthcare expenditure, of -0.24%. When they considered adopting NGS in the future scenario, it resulted in a slight increase in spending over a 3-year horizon of 4.33%.

Ogawa and colleagues said this increase was likely due to a higher percentage of patients testing positive for MEET and NTRK in the future NGS paradigm. These positive results, in turn, would lead to more expensive targeted therapies. Additionally, they noted that many patients in the SSG group would not receive targeted therapy because they would not undergo genetic testing due to unsuccessful biopsies.

Still, the investigators said switching to NGS would have significant benefits for patients, even if it did not lead to cost savings.

“[T]Adoption of future or current NGS tests over SSG tests would shorten the average turnaround time, allowing faster identification of genomic alterations and earlier initiation of treatment for aNSCLC patients in Japan,” they wrote.


Matsuda H, Ogawa T, Sadatsuki Y, et al. Analysis of the budget impact of next-generation sequencing versus sequential single gene testing in Japanese patients with advanced non-small cell lung cancer. Breathe. Investig. 2022.doi:10.1016/j.resinv.2022.10.002

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