Done Right, NGS Makes Economic Sense
When panel 1 was compared with the standard of care, the cost per QALY gained was approximately $144,200, considerably higher than the commonly used threshold of $100,000 per QALY gained.
By contrast, use of panel 3 resulted in a gain in life expectancy of 0.151 year and in QALY of 0.128 per person, at an increased cost of only $4650. The incremental cost-effectiveness ratio (ICER) for panel 3 was $36,500 per QALY gained compared with standard care.
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Adding genes associated with low-penetrance CRCP syndromes (panel 4) produced gains of only 0.010 life-year and 0.009 QALY at a cost of $672, resulting in an ICER of $77,300 compared with panel 3.
Further analysis demonstrated that there is a 74.6% probability that panel 3 is cost-effective at a threshold of $50,000 per QALY gained and a 99.0% probability that it is cost effective at a threshold of $100,000 per QALY gained.
In their conclusion the authors stated, “NGS panels that include these genes should be strongly considered as a first-line test for the evaluation of CRCP syndromes in patients referred to medical genetics clinics.”
- Gallego CJ, Shirts BH, Bennette CS, et al. Next-generation sequencing panels for the diagnosis of colorectal cancer and polyposis syndromes: a cost-effectiveness analysis. J Clin Oncol. May 4, 2015. [Epub ahead of print] pii: JCO.2014.59.3665.