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Appraising the Costs of Genomic Testing for Histology-Independent Technologies: An Illustrative Example for NTRK Fusions

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JournalValue in Health
DateAccepted/In press - 15 Nov 2021
DateE-pub ahead of print - 29 Jun 2022
DatePublished (current) - 1 Jul 2022
Issue number7
Volume25
Number of pages8
Pages (from-to)1133-1140
Early online date29/06/22
Original languageEnglish

Abstract

Objective: Histology-independent (HI) technologies are authorised for advanced/metastatic cancer patients if they express a particular biomarker regardless of its position in the body. Although this represents an important advancement in cancer treatment, genomic testing to identify eligible individuals for HI technologies will require substantial investment and impact their cost-effectiveness. Estimating these costs is complicated by several issues which not only impact the overall cost of testing, but also on the distribution of testing costs across tumour types.

Methods: Key issues that should be considered when evaluating the cost of genomic testing to identify those eligible for HI technology are discussed. These issues are explored in illustrative analyses where costs of genomic testing for NTRK fusions in England for recently approved HI technologies are estimated.

Results: The prevalence of mutation, testing strategy adopted and current testing provision impact the cost of identifying eligible patients. The illustrative analysis estimated the cost of RNA-based NGS to identify one individual with an NTRK fusion ranged between £377 and £282,258. To improve cost-effectiveness, testing costs could be shared across multiple technologies. An estimated, additional ~4,000 patients would need to be treated with other HI
therapies for testing in advanced/metastatic cancer patients to be cost-effective.

Conclusions: The cost of testing to identify individuals eligible for HI technologies impact the drug’s cost-effectiveness. The cost of testing across tumour types varies owing to heterogeneity in the mutation’s prevalence and current testing provision. The cost-effectiveness of HI technologies may be improved if testing costs could be shared across multiple agents.

Bibliographical note

Funding Information:
The authors acknowledge colleagues in the Centre for Reviews and Dissemination and Centre for Health Economics Technology Assessment Group, University of York, who contributed to early discussions on this topic: R. Hodgson, A. Llewellyn, P. Murphy, L. Claxton, L. Beresford, M. Walton, D. Glynn, K. Wright, and S. Dias. Entrectinib for treating NTRK fusion-positive solid tumors: a single technology appraisal. CRD and CHE, University of York, Technology Assessment Group, 2019.

Funding Information:
Funding/Support: This article is based on work completed for the Single Technology Assessment of Entrectinib and Larotrectinib commissioned by the National Institute for Health Research (NIHR) Health Technology Assessment Program, projects numbers NIHR128763 and NIHR127895. This work is also based on ongoing work conducted for the NIHR Health Technology Assessment Program commissioned project: Modeling approaches for site-agnostic cancer drugs to inform National Institute for Health and Care Excellence appraisals, project number NIHR127852.

Funding Information:
Conflict of Interest Disclosures: Miss Beresford reported receiving funding from the National Institute for Health Research as part of the Systematic Review Training Fellowship Scheme. Dr Metcalf reported receiving grants or contracts from Sanofi; receiving consulting fees from AstraZeneca, Bristol Myers Squibb, and Merck Sharp & Dohme; receiving payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or other educational events from Bristol Myers Squibb and Merck Sharp & Dohme; being a member of a data safety monitoring board or advisory board for Achilles Therapeutics, Roche, and Bayer; and receiving support for attending and travelling to meetings from Bayer, Roche, Bristol Myers Squibb and AstraZeneca. No other disclosures were reported.

© 2021, International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

    Research areas

  • cancer, decision making, genomic testing, health technology appraisal, histology independent technologies, targeted therapies

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