Quantifying clinical harm and financial waste from failure to deploy personalized medicine for patients with metastatic non-small cell lung cancer in the United States.

Abstract

e20687 Background: Biomarker panel testing for newly diagnosed metastatic non-small cell lung cancer (mNSCLC) as recommended by the National Comprehensive Cancer Network (NCCN) guidelines, provides the opportunity to match patients with life-prolonging targeted therapies. Nevertheless, biomarker testing for personalized medicine is underutilized in this setting leading to preventable patient deaths and improper healthcare resource utilization. In this study, we evaluated the consequences of suboptimal use of large panel testing, stated in terms of forgone years of life and costs attributed to economic cost of use of less effective nontargeted therapy in the United States (US). Methods: We designed a decision model to estimate annual life years lost (LYL) and associated foregone costs due to suboptimal use of large panel testing versus an optimal testing scenario for patients with advanced NSCLC (adenocarcinoma or large cell carcinoma subtype). The model considered three scenarios: (1) Optimal testing, defined as large panel testing of ≥10 targets recommended by NCCN (2) sub-optimal testing (< 10 genes) and (3) no testing. The proportions of patients identified with actionable targets were based on the number of genes included the panel. Following testing, patients were assigned to targeted or non-targeted treatments, accounting for scenarios where non-targeted therapy was not selected for persons with an identified target and no treatment being administered (e.g., referral to hospice). Proportions of patients with actionable targets (optimal, sub-optimal), treatment selections, costs of targeted and non-targeted therapies, and expected survival for each treatment scenario were based on recently published treatment patterns, costs and survival data in the US. Results: Of the 92,401 newly diagnosed mNSCLC patients with adenocarcinoma or large cell carcinoma diagnosed in the US in 2024, 49,427 (53%) were estimated as prevalent positive for the 10 NCCN targets. Of these, 61% of patients with actionable mutations were identified using suboptimal biomarker testing versus 76% with optimal, NCCN-recommend testing. Among the 19,327 patients currently receiving suboptimal or no testing, there were 8,153 forgone life years due to underutilization of optimal testing (94,678 vs 102,831), with an associated cost of $4.8b ($55.2b vs $60.0b). Conclusions: Among patients with mNSCLC in the United States, suboptimal use of recommended panel testing for newly diagnosed metastatic non-small cell lung cancer (mNSCLC) creates substantial clinical harm and economic loss. Investments in effective programs that focus on closing the performance gap in testing will prolong life expectancy for thousands of mNSCLC patients and provide immediate economic benefits through avoidance of use of ineffective therapies.