OBJECTIVES: Despite providing faster turnaround times, uncertainty around costs and the complexity of reimbursement may limit hospitals willing to invest in in-house next generation sequencing (NGS) technology. Here, the viability of operating an in-house NGS system for advanced non-small cell lung cancer (NSCLC) in Germany is assessed.

METHODS: A decision tree model considering sample sufficiency, test success, samples per batch, and actionable findings estimated the costs and available reimbursement for running an in-house NGS systemin Germany. Outcomes were the return on investment (ROI) after 5 years and the payback period. Cost inputs were consumables, maintenance, staff, and waste disposal. Two different NGS approaches: Comprehensive genomic profiling (CGP) and a hotspot panel were evaluated. Capital costs were list prices, other costs from a single centre in Germany, and the German diagnostic-related group was used for the reimbursement.

RESULTS: For a hospital that processes an average of 50 NSCLC samples per month, the model estimated the total cost per sample to be between €834 and €1,558, depending on the type of NGS performed. A payback period was achieved after 16 to 18 months, with ROI between €2,432,113 to €4,029,342. The average turnaround time from sample reception to result delivery was 3.5 working days (range 3-8). In a scenario analysis, running the maximum possible samples per month for CGP resulted in a positive ROI after 13 months. Key drivers were the reimbursement amount for ROI and the time to reimbursement for the payback period.

CONCLUSIONS: An in-house NGS device for NSCLC profiling in Germany is expected to show a positive ROI after 17 to 19 months. Increased reimbursement would likely encourage more hospitals to invest in in-house NGS. Results will be impacted by use of the NGS machine for other analyses that may or may not be reimbursed under the German healthcare system.