OBJECTIVES: Precision medicine has transformed the treatment of Non-Small Cell Lung Cancer (NSCLC) by targeting specific molecular drivers. Detecting these mutations is essential for a targeted treatment and different methods allow their identification. This study aimed to evaluate the cost-consequence of a 17-gene Next-Generation Sequencing (NGS) panel compared to single-testing for EGFR, ALK and ROS1.

METHODS: Using real-world data from the Porto Portuguese Oncology Institute (IPO Porto), a retrospective observational study was conducted. The control group consisted of 498 NSCLC patients who underwent parallel single-testing using RT-PCR (EGFR) and FISH (ALK and ROS1) from June 2017 to June 2019. The NGS group included 472 NSCLC patients who were submitted to NGS testing from May 2019 to June 2021. Costs associated with each technique (direct material and labour costs) were calculated using Time-driven Activity-Based Costing (TDABC). The number of mutated patients and the number of actionable patients (eligible for EMA-approved targeted therapies) were determined for cost-consequence assessment.

RESULTS: The average cost per patient was €268,16 in the control group and €615,39 in the NGS group. In the latter, 66% (310) of patients had at least one positive gene mutation, compared to 23% (114) in the control group. No statistically significant difference was observed between the number of EGFR, ALK and ROS1 mutations in the two groups. The percentage of actionable patients in the 2 groups was statistically significantly different: 23% (114) in the control group and 40% (191) in the NGS group (p=0,000).

CONCLUSIONS: NGS testing in NSCLC patients allows for the detection of multiple additional gene alterations, which have the potential to inform therapeutic decision-making. Based on the current number of actionable oncogenes and ongoing clinical trials investigating new ones, NGS is potentially cost-saving compared to sequential testing for all known targetable genomic alterations. Further studies should be conducted to validate this hypothesis.