NGS testing for lung cancer across Europe still limited, despite clear case for adoption

• Wealth of evidence for clinical value and cost-saving potential of next-generation sequencing (NGS) testing in lung cancer now available
• Increased uptake requires focus on reimbursement, national standardisation, and new infrastructure

A new report from the Office of Health Economics (OHE) and Takeda, published today, explores the status of access and uptake for NGS testing for lung cancer in Europe. Whilst there is a wealth of evidence, and key EU bodies recommend its use, access remains variable across Europe.

“Our research clearly shows the clinical efficacy and technical superiority of next-generation sequencing over alternatives such as PCR and single gene testing,” said Professor Lotte Steuten, Deputy CEO of OHE and co-author of the report. “This is the cornerstone of the case for expanding its use in lung cancer. Coupled with potential efficiency savings, and a chance to improve patient outcomes, the case for investing in NGS strengthens.”

Lung cancer affects hundreds of thousands of people across Europe every year and NGS testing is well-positioned to provide clinical, economic, and broader patient benefits. However, limited funding, inefficient testing infrastructure, and varying guidance is hampering uptake at the individual country level, although the reasons differ country-to-country.

“Integrating NGS testing into diagnosis and treatment pathways for lung cancer would be a major step towards more personalised cancer care,” said Professor Mike Drummond, University of York. “As new precision therapies become available, the importance of NGS will increase, and the cost-effectiveness of these therapies will depend upon the availability of NGS. But it is difficult for decision-makers to understand and estimate the value of NGS testing. This comprehensive report can support decision-makers contemplating the complex issues surrounding NGS testing for cancer.”

Professor Steuten added: “For the first time, we have a clear, credible, and practical route forward. Our hope is that, across the lung cancer community, this will prompt greater scrutiny of the barriers to NGS use, so that steps are taken to break them down.”

“The case for acting now is compelling,” said Dr Rosa Giuliani, consultant medical oncologist at Guy’s and St Thomas’ NHS Foundation Trust. “Evidence-based guidance on when next-generation sequencing should be used in cases of advanced cancer is clear. However, across large parts of Europe little has changed and we are now at a point where this needs to be urgently addressed. While guidelines are vitally important, we also need to look at improving access to this technology, and the infrastructure needed to support its use. By taking even modest steps now, we can help realise its potential. If we do not act, we risk seeing widening disparity in survival and quality of life for people with lung cancer, as well as time and resources wasted, which health systems cannot afford.”

Barriers to the adoption of NGS vary from country to country, but three generalisable approaches to address them are outlined in the report. These expand into six actionable recommendations that provide a pathway toward greater adoption.

1. The introduction of appropriate pricing and reimbursement mechanisms
   a. Reimbursement of NGS according to its value
   b. National funding support for NGS testing in lung cancer
2. The standardisation of testing and care pathways
   a. National standards for sample analysis and reporting
   b. Local clinical guidelines
3. The development of infrastructure
   a. National education programmes
   b. National mapping of referral pathways

The clinical and economic benefits stem from the ability of NGS testing to generate a molecular profile of an individual patient’s tumour, which informs personalised treatment decisions. This leads to more effective treatments, targeting specific gene mutations, and avoidance of unnecessary treatments that will be ineffective.

The broader benefits of NGS testing, described as the ‘value of knowing’, relate to the observation that a more comprehensive test leads to greater confidence in the treatment for both doctors and patients.

Read the full report now