Could the cost of genomic testing challenge the economic viability of new histology-independent cancer therapies?
Beresford, L. Murphy, P. Dias, S. Claxton, L. Llewellyn, A. Walton, M. Metcalf, Robert Schlecht, H. Ottensmeier, C. Pereira, M.
Beresford, L.
Murphy, P.
Dias, S.
Claxton, L.
Llewellyn, A.
Walton, M.
Metcalf, Robert
Schlecht, H.
Ottensmeier, C.
Pereira, M.
Citations
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Abstract
Purpose:
Two histology independent therapies, entrectinib and larotrectinib, have recently been approved for use in any patient with advanced and metastatic cancer harbouring an NTRK gene fusion. Although this represents an important step-change in the treatment of cancer patients, there are novel
challenges that need to be considered before implementing these drugs in a healthcare setting.
This study aims to assess how the cost of genomic testing may influence the overall costeffectiveness of histology independent Trk-inhibitors, and how cost-effective it would be to
implement pan-cancer NTRK testing in England.
Method(s):
Using the prevalence of NTRK fusions for 31 tumour types, tumour-specific testing costs were
calculated for three testing strategies. These testing costs were used to inform an illustrative
economic analysis, whereby the tumour-specific incremental cost-effectiveness ratio (ICER) of
pan-cancer NTRK fusion testing was estimated using the calculated testing costs and an
estimated incremental benefit of 0.833 QALYs (Canadian Agency for Drugs and Technologies
in Health, 2019).
Result(s):
Owing to substantial differences in the prevalence of NTRK fusions across tumour types, the
number of patients needing to be screened to identify one eligible individual for Trk-inhibitors
ranged from 1.1 (Mammary Analogue Secretory Carcinoma) to 2000 (High Grade Glioma)
patients. Based on the testing costs alone, the average incremental cost of testing to identify one
eligible individual ranged between £83,183 and £199,629 per patient identified, dependent upon
testing strategy adopted. Tumour-specific incremental costs ranged from £0 to £1,479,655 per
patient identified. Estimates of tumour-specific cost-effectiveness varied from less than
£500/QALY in some rare cancers to over £200,000/QALY for some common cancers. Based on
the cost of genomic testing alone, it was estimated that genomic testing was unlikely to be costeffective
in 19 of the tumour types known to harbour an NTRK fusion at a willingness to pay
threshold of £50,000/QALY.
Conclusion(s):
The rarity of NTRK fusions means that the costs of testing are high for most tumour types. This
is likely to considerably impact the cost-effectiveness of TRK inhibitors. Consequently, the
expansion of genomic testing services to include pan-cancer testing does not represent value for
money. Trk-inhibitors are, however, feasibly cost-effective for some tumour types. The costeffectiveness
of Trk-inhibitors in other tumour types may be improved if costs of testing could
be shared across multiple agents.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Beresford L, Murphy P, Dias S, Claxton L, Llewellyn A, Walton M, et al. Could the cost of genomic testing challenge the economic viability of new histology-independent cancer therapies? Medical Decision Making. 2020;40(5):E433-E4.