Economic analysis of BRAF gene mutation testing in real world practice using claims data: costs of single gene versus panel tests in patients with lung cancer

Abstract

Aims: To assess the time to BRAF testing, compare the characteristics of tested vs not-tested patients, and describe the costs for sequential vs next-generation sequencing (NGS) BRAF testing.

Methods: Patients diagnosed with lung cancer after December 1, 2013 were identified from two US claims databases; their characteristics were assessed during the 12 months before diagnosis (index date). Testing modalities were analyzed from the index date to end of continuous health plan enrollment or data availability (December 2015), based on combinations of Current Procedural Terminology (CPT) procedure codes. Time to BRAF testing was assessed using Kaplan-Meier analysis. Costs were analyzed from a payer’s perspective.

Results: A total of 28,011 patients newly-diagnosed with lung cancer were identified. Of them, 1,260 (4.5%) were tested for BRAF: 3.2% and 4.2% were tested at 6 and 12 months, respectively, after the index date. Compared to non-tested patients, tested patients were younger (58.3 vs 65.3 years; p < .001), had a lower Charlson Comorbidity Index (2.8 vs 2.9; p = .005), and a higher proportion had metastases (70.9% vs 43.4%; p < .001). In 76.0% of cases, BRAF was tested along with KRAS. BRAF was tested using NGS in 6.6% of cases. The average reimbursed amounts for the 10 most common CPT code combinations were $207–$2,074. Using the average costs of individual mutation tests, the total cost of sequential testing comprising KRAS, EGFR, ALK, ROS1, and BRAF tests was $3,763 ($464, $696, $1,070, $1,127, and $406, respectively), that of NGS was $2,860.

Limitations: Claims data did not include BRAF test results.

Conclusions: Among patients newly-diagnosed with lung cancer, 4.5% were tested for BRAF. Tested patients were younger and had a lower comorbidity burden, but more advanced disease. While reimbursed amounts varied greatly based on combinations of testing procedures, NGS testing was associated with cost savings compared to sequential testing of individual mutations.

Keywords:

• Non-small cell lung cancer
• BRAF mutation
• costs
• sequential testing
• next-generation sequencing
• NGS

Transparency

Declaration of funding

Funding for this research was provided by Novartis Pharmaceuticals Corporation.

Declaration of financial/other relationships

AAD, AM, and KWC are employees of Novartis Pharmaceuticals Corporation and may own stock or stock options. AG is an employee of Analysis Group, Inc., which has received consultancy fees from Novartis Pharmaceuticals Corporation for this study. JME peer reviewers for this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We would like to thank Cinzia Metallo, PhD, an employee of Analysis Group, Inc., for medical writing assistance.

Previous presentations

A synopsis of the current research was presented in poster format at the Academy of Managed Care Pharmacy (AMCP) 2017 Nexus Meeting, which took place in Dallas, TX, in October 2017, and the National Association of Specialty Pharmacy (NASP) annual meeting, which took place in Las Vegas, NV, in November 2017.