Economic Value of Next Generation Sequencing Panels in Oncology - A Market Development Perspective

Next generation sequencing (NGS) panels are being used increasingly in oncology to test many genes at once, identify different mutation types, improve patient enrollment for clinical trials and guide targeted therapy decisions. Our objective was to review the current landscape of economic studies of NGS in oncology, identify the gaps in the literature and suggest recommendations to address those gaps. We conducted a review of the literature from January 2007 to July 2017 using specific search terms in different databases including, PubMed, Embase, National Health Service (NHS) Economic Evaluation Database (EED) and EconLit. We assessed the data on costs, outcomes, choice of comparator, timeframe of analysis and the method of economic evaluation used for NGS panels in cancer patients. We identified 12 original economic evaluation studies: cost-effectiveness analyses were the most common methods of economic evaluations (N=5) followed by micro-costing and budget impact (N=3), cost comparison (N=2), cost of care (N=1), and cost analysis based on retrospective databases (N=1). We found significant variability between studies, impacting the ability to draw firm conclusions: 1) studies evaluated NGS in 9 different populations based on tumor types 2) the choice of comparator was not similar across the economic studies 3) there was a lack of consistency in the assumptions for resource costs. Finally, we noted that studies analyzed population health outcomes (e.g. cost of treatment, life years added and quality of life of patients) over patient centered outcomes (e.g. the value of possessing genomic information or its impact on medication adherence). Economic utility evidence associated with NGS panels in oncology is inadequate to date, and this variability on the data of economic parameters may be contributing to negative or delayed coverage decisions from healthcare payers. We suggest a checklist for future economic evaluation studies of NGS panels in oncology.