Spencer et al. publish a nice health economics paper on the cost effectiveness of CGP. It compares US and German cost-effectiveness in several scenarios.
- Absolute increase in survival between standard panel and CGP large panel was 0.1 year (5 weeks survival).
- Cost per QALY was $175,000 (implying circa $17,000 cost per that 0.1 year).
- Authors use 3,800 patientts in Syapse for data.
It's not open access but J Molec Dx comes with a membership in AMP.
https://pubmed.ncbi.nlm.nih.gov/40701291/
Cost-Effectiveness Analysis of Comprehensive Genomic Profiling in Patients with Advanced Non-Small-Cell Lung Cancer Using Real-World Data
Scott Spencer 1, Weicheng Ye 2, Siyang Peng 3, Denise Zou 2 [ILMN & TFS]
PMID: 40701291 https://www.jmdjournal.org/article/S1525-1578(25)00165-5/fulltext
Abstract
Cancer treatment costs pose a significant global economic burden. By facilitating treatment plans tailored to the genomic profile of patients' cancer, genomic testing has the potential to reduce health care costs. Using real-world evidence, this study compared the cost-effectiveness of comprehensive genomic profiling (CGP) versus small panel (SP) testing in patients with advanced non-small-cell lung cancer in the United States and Germany.
A partitioned survival model was developed to estimate the life years and drug acquisition costs associated with CGP and SP testing in patients receiving matched targeted therapy, matched immunotherapy, or no matched therapy/untreated.
Key model parameters were informed by real-world data derived from the Syapse study. Scenario and sensitivity analyses were conducted. CGP improved the average overall survival by 0.10 years compared with SP.
CGP was associated with higher health care costs because of a higher percentage of patients receiving targeted therapies. The estimated incremental cost-effectiveness ratio (ICER) of CGP versus SP was $174,782 and $63,158 per life-year gained in the United States and Germany, respectively. Increasing the number of patients receiving treatment decreased the ICERs ($86,826 in the United States and $29,235 in Germany), while switching from immunotherapy plus chemotherapy to chemotherapy alone increased the ICERs ($223,226 in the United States and $83,333 in Germany).
Altogether, CGP has the potential to improve patient outcomes and is more cost-effective than SP.
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I asked Chat GPT 5 for its take on the article.
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Does CGP Really Make a Difference Over Small Panels?
A new JMD cost-effectiveness study asks the pointed question: does broad comprehensive genomic profiling (CGP) really improve outcomes over more focused small panel (SP) testing in advanced NSCLC?
The answer, based on real-world data, is: yes, but only a little. Patients tested with CGP lived an average of 0.1 year longer — about five weeks of added survival — compared with those tested on small panels. That’s not nothing, but it’s a modest gain, especially when seen against the costs.
On the economic side, the authors report that CGP cost $175,000 per life-year gained in the U.S.. That’s on the edge (or beyond) the usual willingness-to-pay thresholds used in U.S. health economics. The main driver? Patients identified by CGP are more likely to receive expensive targeted drugs, raising overall treatment costs.
Interestingly, the story looks better in Germany, where drug prices are regulated and significantly lower. There, the incremental cost-effectiveness ratio was only $63,000 per life-year gained — a far more palatable number. The difference highlights how drug pricing policy, not just diagnostic technology, shapes cost-effectiveness.
Policy takeaway: Whether CGP “makes a difference” depends on how you measure it. Clinically, the added benefit over small panels is modest. Economically, in the U.S. it comes at a very high cost per year of life gained, while in Germany it falls into a range that would generally be considered cost-effective. This underscores a bigger point: debates over the value of CGP are really debates over how much we’re willing to pay for marginal gains in survival — and whether drug prices should be allowed to dominate that equation.
Pricing was a little quirky.
According to Chat GPT, they used standard CMS CLFS pricing for large and small panels ($2919, $597). According to Chat GPT, the same price (for German code 19424) was used for either panel size ,being (E) 2973 or $3218.
