Clinical players and healthcare payers: aligning perspectives on the cost–effectiveness of next-generation sequencing in oncology

Recent discussion surrounding the clinical implementation of genome sequencing has touted its cost–effectiveness [1]. However, the simplistic assumption that lowering the cost of next-generation sequencing (NGS) testing equates to cost–effectiveness is misguided and lacks evidence. Wide spread NGS testing in oncology will incur large upfront screening costs; potentially with no impact on treatment outcomes. In those instances where valuable information is revealed the use of an expensive targeted therapy is likely to be indicated. Therefore, it is essential to have reliable clinical and economic evidence supporting the clinical implementation of tumor-focused NGS testing. Inappropriate use could result in inefficiencies; reducing societies’ ability to provide (quality) healthcare to others.

There are a number of challenges facing cancer centers looking to implement NGS and healthcare payers responsible for its reimbursement. Cancer centers need to determine the most suitable patient populations to receive NGS testing, where suitability is supported by the test’s analytical validity, clinical utility and cost–effectiveness. Payers will require this supporting evidence to determine if testing results in beneficial and cost-effective outcomes. Additionally, the uncertainty surrounding test outcomes, means payers will need to be more flexible in their approach to reimbursement – that is, share the risk with the cancer centers providing testing.

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