Cost Effectiveness of Sequencing 34 Cancer-Associated Genes as an Aid for Treatment Selection in Patients with Metastatic Melanoma.
OBJECTIVE
To determine whether a next-generation sequencing (NGS) panel of 34 cancer-associated genes would cost-effectively aid in the treatment selection for patients with metastatic melanoma, compared with a single-site BRAF V600 mutation test.


METHODS
A decision model was developed to estimate the costs and health outcomes of the two test strategies. The cost effectiveness of these two strategies was analyzed from a payer perspective over a 2-year time horizon with model parameters taken from the literature.


RESULTS
In the base case, the gene sequencing panel strategy resulted in a cost of US$120,022 and 0.721 quality-adjusted life years (QALYs) per patient, whereas the single-site mutation test strategy resulted in a cost of US$128,965 and 0.704 QALYs. Thus, the gene sequencing panel strategy cost US$8943 less per patient and increased QALYs by 0.0174 per patient. Sensitivity analyses showed that, compared with the single-site mutation test strategy, the gene sequencing panel strategy had a 90.9% chance of having reduced costs and increased QALYs, with the cost of the gene sequencing panel test having minimal effect on the incremental cost.


CONCLUSIONS
Compared with the single-site mutation test, the use of an NGS panel of 34 cancer-associated genes as an aid in selecting therapy for patients with metastatic melanoma reduced costs and increased QALYs. If the base-case results were applied to the 8900 patients diagnosed with metastatic melanoma in the USA each year, the gene sequencing panel strategy could result in an annual savings of US$79.6 million and a gain of 155 QALYs.
Quest Diagnostics, Alameda and San Juan Capistrano, Alameda, CA, 94502, USA, yonghong.li@celera.com.
Yonghong
Y
Li
Lance A
LA
Bare
Richard A
RA
Bender
John J
JJ
Sninsky
Leslie S
LS
Wilson
James J
JJ
Devlin
Frederic M
FM
Waldman
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D020022:Genetic Predisposition to Disease; D005102:Health Expenditures; D059014:High-Throughput Nucleotide Sequencing / Q000191:economics*; D006801:Humans; D008545:Melanoma / Q000191:economics / Q000235:genetics*; D018803:Models, Economic; D009154:Mutation; D009362:Neoplasm Metastasis; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D017422:Sequence Analysis, DNA / Q000191:economics*
C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf