OBJECTIVES: Comprehensive genomic profiling (CGP) may offer advantages to cancer patients, but the economic and clinical impacts are uncertain, partly because performing randomized comparative studies is challenging in this field. Therefore, this study aimed to perform an early cost-consequence analysis of CGP alongside the BALLETT; a single arm, nation-wide clinical study in a metastasized tumor-agnostic population in Belgium.

METHODS: A cost-consequence decision tree was developed to examine the diagnostic cost and benefits of CGP compared to no further testing. Benefits were expressed as i) probability for a patient to have an actionable target (AT), and ii) probability for a patient to receive a matched treatment (MT). Clinical data was obtained from the BALLETT study that provided CGP to 814 advanced cancer patients. CGP costs were obtained from a micro-costing study performed alongside the BALLETT study. Threshold analyses were performed to explore for what input parameters CGP would be cost-effective, using the Net Monetary Benefit (NMB) and a willingness to pay of €2.000 for AT and €5.000 for MT.

RESULTS: Diagnostic costs of the CGP strategy were €2.030, with a 0.76 probability for AT and a 0.11 probability for MT. Cost-effectiveness ratios were €2.680 and €18.139 per identified patient with an AT and MT, respectively. Subgroup analyses for lung, breast and sarcoma cancers showed incremental costs per identified patient with AT[MT] of €2.357[€9.722], €2.266[€15.860], €4.118[€16.470], respectively. Given our assumed WTP, threshold analyses showed a positive NMB for MT when costs of CGP decreased to €500 or when 42% of patients with actionable targets receive matched treatments.

CONCLUSIONS: The cost-effectiveness of CGP to match a treatment varied between tumor types. The conversion rate of actionable patients to matched treatments had a strong impact on the NMB. Further research is needed on establishing WTP thresholds for outcomes of CGP, and on the downstream effects of these outcomes.