OBJECTIVES: Targeted therapies have prompted increased use of comprehensive genomic profiling (CGP) to identify treatment-eligible patients. There are several testing options available including OncoExTra^TM, a whole exome (WES), whole transcriptome (WTS) NGS test with tumor normal pairing. Here costs and outcomes of using the OncoExTra test were modeled.

METHODS: A Microsoft Excel-based model was developed to evaluate patients with advanced/metastatic NSCLC, breast, prostate, or colorectal cancer (CRC). Pairwise comparisons were conducted for an average patient assessed with various testing strategies (CGP, small panels, single gene, no testing). Separately, a hypothetical plan of one-million members receiving the currently used variety of tests was assessed with/without incorporation of the OncoExTra test. Treatment pathways were based on NCCN guidelines and expert opinion. Inputs were derived from published literature including test characteristics and treatment costs. Annual results were estimated by cancer type and all cancers combined. Sensitivity analyses were conducted.

RESULTS: Compared to single gene testing (not applicable for prostate), incorporation of the OncoExTra test increased actionable alterations identified across all patients while decreasing costs by $14,602 per NSCLC and $885 per CRC patient, although costs increased in breast cancer by $2,866. In population-level analyses, 858 patients (0.1%) were eligible for testing. Using the OncoExTra test in 5% of patients decreased per-member per-month costs by $0.0033 overall, ranging from a cost-savings of 0.0261 in NSCLC to an $0.0086 increase in prostate cancer. Cost-savings were driven by reduced direct/indirect medical and pharmacy costs and increased clinical trial enrollment. Using the OncoExTra test increased the proportion of identified actionable mutations by 3.0% across tumor types. In sensitivity analyses, results were most impacted by treatment costs and market share.

CONCLUSIONS: Among patients with advanced/metastatic NSCLC, breast, prostate, and CRC using a WES/WTS NGS test such as the OncoExTra test increases alterations identified with minimal budget impact.