OBJECTIVES: CGP is a next‐generation sequencing testing with broad spectrum. While the frequency of EGFR mutation rate is around half for patients in East Asian ethnicities, payers may intend to lower budget impact through restricting CGP reimbursement to subgroups. This research is a thoughtful analyses among different scenarios comparing between CGP as the first molecular diagnosis and after EGFR/ALK/ROS-1 testing.

METHODS: A budget impact analysis model was developed comparing the sum of gene testing costs, the first line and subsequent systemic treatment costs, and other medical costs between the current practice of traditional molecular testing and the new test strategies of CGP. The impact of the CGP assumption with higher detection rates of EGFR and ALK is also evaluated in various scenarios. Outcome endpoints were incremental budget impact and life year gained.

RESULTS: In the condition that CGP can detect more EGFR and ALK mutation, when reimbursement population changed from all advanced NSCLC patients to wild type patients, the incremental gene test cost of this alternative scenario in 2026 becomes 57% of base case because of fewer patients. However, the incremental budget impact of the alternative scenario increased by 43%, due to increased anti-neoplastic treatment cost and other medical costs. If CGP doesn’t demonstrate higher detection rate of EGFR and ALK mutation, CGP reimbursement in the base case could save USD 10.83 million comparing the current testing strategy with single gene testing. In the alternative scenario, the incremental budget impact went up to USD 1.01 million due to increased anti-neoplastic treatment cost and other medical costs. The incremental life year gained of the alternative scenario is much less than the base case.

CONCLUSIONS: CGP reimbursement for all advanced NSCLC would have less budget impact than for the subgroup of wild type patients while yielding more life year gained.