Appraising the Costs of Genomic Testing for Histology-Independent Technologies : An Illustrative Example for NTRK Fusions

Objective: Histology-independent (HI) technologies are authorised for advanced/metastatic cancer patients if they express a particular biomarker regardless of its position in the body. Although this represents an important advancement in cancer treatment, genomic testing to identify eligible individuals for HI technologies will require substantial investment and impact their cost-effectiveness. Estimating these costs is complicated by several issues which not only impact the overall cost of testing, but also on the distribution of testing costs across tumour types. Methods: Key issues that should be considered when evaluating the cost of genomic testing to identify those eligible for HI technology are discussed. These issues are explored in illustrative analyses where costs of genomic testing for NTRK fusions in England for recently approved HI technologies are estimated. Results: The prevalence of mutation, testing strategy adopted and current testing provision impact the cost of identifying eligible patients. The illustrative analysis estimated the cost of RNA-based NGS to identify one individual with an NTRK fusion ranged between £377 and £282,258. To improve cost-effectiveness, testing costs could be shared across multiple technologies. An estimated, additional ~4,000 patients would need to be treated with other HI therapies for testing in advanced/metastatic cancer patients to be cost-effective. Conclusions: The cost of testing to identify individuals eligible for HI technologies impact the drug’s cost-effectiveness. The cost of testing across tumour types varies owing to heterogeneity in the mutation’s prevalence and current testing provision. The cost-effectiveness of HI technologies may be improved if testing costs could be shared across multiple agents.