Expanding next-generation sequencing (NGS) testing for patients with metastatic colorectal cancer (mCRC) could support the upfront detection of biomarkers for targeted treatment without incurring a significant uptick in costs, according to findings presented at AMCP 2023.

“The detection of (often rare) genomic biomarkers has the potential to change the treatment paradigm and improve patient outcomes,” researchers said. “While new and emerging therapies are targeted for patients with actionable gene alterations, testing for biomarkers remains inconsistent and relatively limited.”

The authors developed a number needed to test model to understand how expanded biomarker testing might impact the detection of actionable genetic alterations. The patients in the model were on their first line of therapy for mCRC. The model was designed from a US commercial payer perspective and followed the National Comprehensive Cancer Network’s biomarker testing guidelines, including testing for BRAF, RAS, MSI, HER2, NTRK, and TMB mutations. 

“Model inputs were from published literature (for biomarker prevalence), CMS fee schedule (for costs), and real-world claims databases and surveys (for testing rates and testing methodology),” researchers noted. 

Researchers modeled two scenarios over 5 years: 

• a ‘base case’ where 50% of all testing was NGS testing and the other 50% was single gene testing; and 
• an ‘NGS increase’ where NGS comprised 75% of tests and the remaining 25% was single gene testing.

Increasing the use of NGS testing resulted in a 26% reduction in the number needed to test to identify an actionable alteration, from 3.5 to 2.6 patients. Greater use of NGS testing also lowered the overall number of tests from 2927 to 2681 (-8%), while increasing the detection of actionable biomarker alterations from 844 to 1048 (+24%).

Researchers said the expanded use of NGS testing had a “manageable impact on costs.” Estimated costs increased from $0.16 to $0.23 per member per month, according to the findings.

In this model, expanded NGS testing yielded “an increase in detection of actionable biomarkers included in the NCCN guidelines, presenting opportunities for targeted treatment, all within a manageable budget. Upfront NGS testing for all patients with mCRC should be more widely considered in order to inform treatment choices,” researchers concluded.

Reference:
Bonetti G, Hsu LI, Siadak M, Beckerman R. Economic impact of biomarker testing in metastatic colorectal cancer: Number needed to test and budget impact from US payer perspective. J Manag Care Spec Pharm. 2023;29(10-a suppl):S1-S137. https://www.jmcp.org/pb-assets/Poster%20Abstract%20Supplements/AMCP2023_PosterAbstractSupplement_0317-1679318682267.pdf