Background Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc). However, newer testing options such as comprehensive genomic profiling (cgp) offer improved detection rates and identification of multiple classes of genomic alterations in a single assay, minimizing tissue requirements and turnaround time. The objective of the present analysis was to assess the health and budget impacts of adopting cgp testing for nsclc in Canada. Methods This study assessed the impact of funding the cgp tests FoundationOne CDx and FoundationOne Liquid (Foundation Medicine, Cambridge, MA, U.S.A.) over a 3-year time horizon using a Canadian societal perspective for Ontario. Conventional testing strategies were summarized into two reference scenarios: a series of single-gene tests only, and reflex single-gene testing followed by a hotspot panel for negative results. Four adoption scenarios for cgp testing were considered: replacing all single-gene and hotspot panel testing, replacing hotspot panel testing only, use after negative single-gene and hotspot testing, and use of FoundationOne Liquid in individuals with insufficient tissue for conventional testing. Results When cgp testing was assumed to replace all conventional testing with 50% uptake, the budget impact per person per year ranged from $0.71 to $0.87, depending on the reference scenario, with a 3-year gain of 680.9 life-years and 3831 working days over the full cohort. Conclusions Given the present testing landscape for patients with nsclc in Canada, listing cgp testing could optimize the selection of appropriately targeted treatments, and thus add life-years and productivity for this population, with a minimal budget impact.

中文翻译：

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非小细胞肺癌的全面基因组分析：健康和预算影响

背景 针对特定生物标志物子集的单基因测试和热点组合构成了加拿大非小细胞肺癌 (nsclc) 基因组测试的格局。然而，综合基因组分析 (cgp) 等较新的测试选项可提高检测率，并在单次检测中识别多类基因组改变，从而最大限度地减少组织需求和周转时间。本分析的目的是评估加拿大对非小细胞肺癌采用 cgp 检测对健康和预算的影响。方法 本研究从加拿大安大略省的社会角度评估了资助 cgp 测试 FoundationOne CDx 和 FoundationOne Liquid（美国马萨诸塞州剑桥市 Foundation Medicine）在 3 年时间范围内的影响。传统的检测策略总结为两种参考场景：仅进行一系列单基因检测，以及反射性单基因检测，然后进行热点小组检测阴性结果。考虑了 cgp 测试的四种采用方案：替换所有单基因和热点面板测试、仅替换热点面板测试、在单基因和热点测试阴性后使用、以及在组织不足以进行常规测试的个体中使用 FoundationOne Liquid。结果 当假设 cgp 测试以 50% 的采用率取代所有传统测试时，每人每年的预算影响范围为 0.71 美元至 0.87 美元（具体取决于参考场景），3 年增益为 680.9 个生命年和 3831 个工作日超过整个队列。结论 鉴于加拿大 nsclc 患者目前的检测情况，列出 cgp 检测可以优化适当针对性治疗的选择，从而延长该人群的寿命和生产力，同时对预算影响最小。