Costs associated with the use of multigene panel tests in three solid tumor types and the impact on insurance premiums

Abstract

Aim: This study assessed the costs associated with multigene panel tests (MGPTs) in the USA and the impact of coverage on insurance premiums. Materials & methods: We conducted a retrospective claims analysis to estimate total patient costs associated with MGPT use in three solid tumors: advanced non-small-cell lung cancer, advanced melanoma and metastatic colorectal cancer. A decision analytic model was constructed to estimate the premium impact of a 1 million member commercial health plan. Results: In all three tumor types, mean total costs for patients receiving or not receiving MGPTs were not significantly different (p > 0.05). The estimated change in premiums per enrollee per month was estimated to be US$0.040. Conclusion: MGPTs were not associated with higher costs and coverage is expected to have minimal impact on insurance premiums.

Plain language summary

Costs & premiums for tests of biomarkers

We examined whether using tests for many biomarkers at once in three cancer types would lead to higher costs and increase insurance premiums for patients with private insurance. Using real-world data, we found that use of these tests was not linked to higher costs. Furthermore, we estimated that insurance coverage of these tests would result in small changes to insurance premiums.

Keywords::

• budget impact
• costs
• insurance coverage
• insurance premiums
• multigene panel tests
• next-generation sequencing

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/fon-2023-0094

Author contributions

Concept and design: D Sheinson, TM To, W Wong. Acquisition, analysis or interpretation: Y Liu, D Sheinson, TM To, W Wong, Y Liu. Drafting or revising manuscript: Y Liu, D Sheinson, TM To, W Wong. Final approval of manuscript: Y Liu, D Sheinson, TM To, W Wong.

Financial & competing interests disclosure

This study was funded by Genentech, Inc. D Sheinson, TM To and W Wong are employees of Genentech, Inc. and have Roche Stock. Y Liu is an employee of Genesis Research, which received funding from Genentech, Inc. in connection with this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Medical writing support was provided by J Carthy and R Hornby of Oxford PharmaGenesis (Oxford, UK), and was funded by Genentech, Inc.

Additional information

Funding

This study was funded by Genentech, Inc. D Sheinson, TM To and W Wong are employees of Genentech, Inc. and have Roche Stock. Y Liu is an employee of Genesis Research, which received funding from Genentech, Inc. in connection with this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.