Giancarlo Pruneri1,2, Filippo De Braud3,2, Anna Sapino4,5, Massimo Aglietta6,7, Andrea Vecchione8, Raffaele Giusti9, Caterina Marchiò4,5, Stefania Scarpino8, Anna Baggi10, Giuseppe Bonetti10, Jean Marie Franzini10, Marco Volpe10, Claudio Jommi11. 1. Department of the Pathology and Laboratory Medicine, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy. 2. School of Medicine, University of Milan, Milan, Italy. 3. Department of Oncology, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy. 4. Pathology Unit, Candiolo Cancer Institute-FPO-IRCCS-Candiolo, Turin, Italy. 5. Department of Medical Sciences, University of Turin, Turin, Italy. 6. Medical Oncology, Candiolo Cancer Institute-FPO-IRCCS-Candiolo, Turin, Italy. 7. Department of Oncology, University of Torino, Turin, Italy. 8. Pathology Unit, Department of Clinical and Molecular Medicine, St. Andrea University Hospital, University of Rome La Sapienza, Rome, Italy. 9. Medical Oncology Unit, St. Andrea University Hospital, Rome, Italy. 10. Life Sciences Division, Business Integration Partners, Milan, Italy. 11. Cergas, Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy. claudio.jommi@unibocconi.it.
Abstract
OBJECTIVES: This study aimed to compare the costs of a next-generation sequencing-based (NGS-based) panel testing strategy to those of a single-gene testing-based (SGT-based) strategy, considering different scenarios of clinical practice evolution. METHODS: Three Italian hospitals were analysed, and four different testing pathways (paths 1, 2, 3, and 4) were identified: two for advanced non-small-cell lung cancer (aNSCLC) patients and two for unresectable metastatic colon-rectal cancer (mCRC) patients. For each path, we explored four scenarios considering the current clinical practice and its expected evolution. The 16 testing cases (4 scenarios × 4 paths) were then compared in terms of differential costs between the NGS-based and SGT-based approaches considering personnel, consumables, equipment, and overhead costs. Break-even and sensitivity analyses were performed. Data gathering, aimed at identifying the hospital setup, was performed through a semi-structured questionnaire administered to the professionals involved in testing activities. RESULTS: The NGS-based strategy was found to be a cost-saving alternative to the SGT-based strategy in 15 of the 16 testing cases. The break-even threshold, the minimum number of patients required to make the NGS-based approach less costly than the SGT-based approach, varied across the testing cases depending on molecular alterations tested, techniques adopted, and specific costs. The analysis found the NGS-based approach to be less costly than the SGT-based approach in nine of the 16 testing cases at any volume of tests performed; in six cases, the NGS-based approach was found to be less costly above a threshold (and in one case, it was found to be always more expensive). Savings obtained using an NGS-based approach ranged from €30 to €1249 per patient; in the unique testing case where NGS was more costly, the additional cost per patient was €25. CONCLUSIONS: An NGS-based approach may be less costly than an SGT-based approach; also, generated savings increase with the number of patients and different molecular alterations tested.
OBJECTIVES: This study aimed to compare the costs of a next-generation sequencing-based (NGS-based) panel testing strategy to those of a single-gene testing-based (SGT-based) strategy, considering different scenarios of clinical practice evolution. METHODS: Three Italian hospitals were analysed, and four different testing pathways (paths 1, 2, 3, and 4) were identified: two for advanced non-small-cell lung cancer (aNSCLC) patients and two for unresectable metastatic colon-rectal cancer (mCRC) patients. For each path, we explored four scenarios considering the current clinical practice and its expected evolution. The 16 testing cases (4 scenarios × 4 paths) were then compared in terms of differential costs between the NGS-based and SGT-based approaches considering personnel, consumables, equipment, and overhead costs. Break-even and sensitivity analyses were performed. Data gathering, aimed at identifying the hospital setup, was performed through a semi-structured questionnaire administered to the professionals involved in testing activities. RESULTS: The NGS-based strategy was found to be a cost-saving alternative to the SGT-based strategy in 15 of the 16 testing cases. The break-even threshold, the minimum number of patients required to make the NGS-based approach less costly than the SGT-based approach, varied across the testing cases depending on molecular alterations tested, techniques adopted, and specific costs. The analysis found the NGS-based approach to be less costly than the SGT-based approach in nine of the 16 testing cases at any volume of tests performed; in six cases, the NGS-based approach was found to be less costly above a threshold (and in one case, it was found to be always more expensive). Savings obtained using an NGS-based approach ranged from €30 to €1249 per patient; in the unique testing case where NGS was more costly, the additional cost per patient was €25. CONCLUSIONS: An NGS-based approach may be less costly than an SGT-based approach; also, generated savings increase with the number of patients and different molecular alterations tested.
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