Clinical and economic value of comprehensive genomic profiling in patients with advanced solid cancers using Australian real-world data: Preliminary analyses.

Abstract

e15084 Background: Single gene assays constitute the most common modality used to detect actionable genomic biomarkers in cancer tissue in Australian clinical practice, while comprehensive genomic profiling (CGP) is not the current standard of care (SoC). This study explored the impact of the adoption of CGP on the chance of receiving matched targeted therapies in a retrospective cohort of Australian patients (recruited from July 2020 to June 2023) with advanced cholangiocarcinoma (CCA), colorectal cancer (CRC), or non-small cell lung cancer (NSCLC). Methods: A partitioned survival model was developed to compare health outcomes and medical costs between scenarios where CGP is unvailable versus the current SoC in Australia with limited CGP use. For each cancer type, the cohort was stratified into three sub-cohorts based on the therapy received: matched targeted therapy, unmatched therapy, or no therapy. Overall survival was informed by patient-level data from the Australian Molecular Screening and Therapeutics (MoST) program from patients who exhausted all lines of SoC. Outpatient healthcare costs and prescribed medicines were informed by the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme (provided by Services Australia). The survival and cost inputs were stratified by the cancer type and three sub-cohorts. Quality of life was assessed using the EQ-5D-5L. Patients were assumed to equally receive unmatched therapy or no therapy before CGP was available, while the alternative scenario reflected the current distribution observed in the MoST program. Results: Patientsreceiving matched targeted therapy exhibited longer survival than those receiving unmatched therapy or no therapy (see Table). The undiscounted results showed that compared with the scenario where CGP was unavailable, the current CGP use in the MoST program led to incremental life years of 0.30 for CCA, 0.17 for CRC, and 0.15 for NSCLC and incremental quality-adjusted life years (QALYs) of 0.25 for CCA, 0.13 for CRC, and 0.12 for NSCLC. With the application of healthcare costs, these translate into incremental costs/QALY gained of $1,210 for CCA, $6,807 for CRC, and $1,248 for NSCLC. Conclusions: CGP has the potential to improve patient health outcomes and may be cost-effective for advanced solid cancers compared with single gene assays. Sub-cohort/scenario Mean survival (undiscounted, years) CCA n=163 CRC n=188 NSCLC n=61 Matched targeted therapy 3.44 2.64 1.80 Unmatched therapy 1.22 1.96 1.27 No therapy 1.17 1.04 1.08 Before CGP is available (50% unmatched therapy + 50% no therapy for all cancers) 1.20 1.50 1.18 After CGP is available 1.50 (assuming 13% matched therapy + 40% unmatched therapy + 46% no therapy 1.67 (assuming 19% matched therapy + 36% unmatched therapy + 46% no therapy 1.33 (assuming 26% matched therapy + 30% unmatched therapy + 44% no therapy