Costs of biomarker testing among patients with metastatic lung or thyroid cancer in the USA: a real-world commercial claims database study

Figures & data

Figure 1. Study cohorts.

Table 1. Patient characteristics at diagnosis.

Characteristic	Lung cancer	Metastatic lung cancer	Thyroid cancer	Metastatic thyroid cancer
Number of patients (n)	23,633	13,320	36,867	2,241
Year of initial diagnosis, n (%)
2015	5,559 (23.5)	3,373 (25.3)	8,362 (22.7)	593 (26.5)
2016	5,138 (21.7)	2,934 (22.0)	8,217 (22.3)	520 (23.2)
2017	4,923 (20.8)	2,734 (20.5)	8,272 (22.4)	442 (19.7)
2018	5,127 (21.7)	2,764 (20.8)	8,390 (22.8)	480 (21.4)
2019	2,886 (12.2)	1,515 (11.4)	3,626 (9.8)	206 (9.2)
Age, mean (SD) years	57.0 (6.6)	56.5 (6.7)	45.6 (11.5)	46.0 (12.8)
Gender, n (%)
Female	12,781 (54.1)	6,949 (52.2)	28,827 (78.2)	1,458 (65.1)
Male	10,830 (45.8)	6,361 (47.8)	8,012 (21.7)	780 (34.8)
Unknown/missing	22 (0.1)	10 (0.1)	28 (0.1)	3 (0.1)
Region, n (%)
North Central	5,389 (22.8)	3,086 (23.2)	6,879 (18.7)	427 (19.1)
Northeast	4,516 (19.1)	2,434 (18.3)	8,255 (22.4)	520 (23.2)
South	11,114 (47.0)	6,265 (47.0)	15,309 (41.5)	907 (40.5)
West	2,528 (10.7)	1,492 (11.2)	6,242 (16.9)	377 (16.8)
Unknown/missing	86 (0.4)	43 (0.3)	182 (0.5)	10 (0.5)
Health care plan type, n (%)
Comprehensive	1,157 (4.9)	678 (5.1)	750 (2.0)	42 (1.9)
EPO	188 (0.8)	104 (0.8)	369 (1.0)	29 (1.3)
HMO	2,499 (10.6)	1,375 (10.3)	4,043 (11.0)	242 (10.8)
POS	2,059 (8.7)	1,119 (8.4)	3,723 (10.1)	208 (9.3)
PPO	13,211 (55.9)	7,474 (56.1)	19,935 (54.1)	1,223 (54.6)
POS with capitation	277 (1.2)	146 (1.1)	475 (1.3)	35 (1.6)
CDHP	2,099 (8.9)	1,212 (9.1)	3,147 (8.5)	191 (8.5)
Other/missing	2,143 (9.1)	1,212 (9.1)	4,425 (12.0)	271 (12.1)
Duration of follow-up, mean (SD) months	14.2 (12.0)	12.6 (11.1)	22.8 (14.3)	22.2 (14.9)

Abbreviations. SD, standard deviation; EPO, exclusive provider organization; HMO, health maintenance organization; POS, point-of-service; PPO, preferred provider organization; CDHP, consumer directed health plan.

Table 2. Characteristics of patients with lung cancer, with and without biomarker testing codes.

	Lung cancer N = 23,633		Metastatic lung cancer N = 13,320
	With biomarker codes	No biomarker codes	With biomarker codes	No biomarker codes
Number of patients, n (%)^a	16,169 (68.4)	7,464 (31.6)	10,100 (75.8)	3,220 (24.2)
At least one comprehensive/NGS biomarker code, n (%)^b	1,221 (7.6)	0 (0.0)	897 (8.9)	0 (0.0)
Year of initial diagnosis, n (%)^b
2015	3,775 (23.4)	1,784 (23.9)	2,528 (25.0)	845 (26.2)
2016	3,581 (22.2)	1,557 (20.9)	2,287 (22.6)	647 (20.1)
2017	3,391 (21.0)	1,532 (20.5)	2,111 (20.9)	623 (19.4)
2018	3,427 (21.2)	1,700 (22.8)	2,066 (20.5)	698 (21.7)
2019	1,995 (12.3)	891 (11.9)	1,108 (11.0)	407 (12.6)
Age, mean (SD) years^b	56.97 (6.5)	56.91 (6.9)	56.55 (6.6)	56.45 (7.0)
Gender, n (%)^b
Female	8,735 (54.0)	4,046 (54.2)	5,302 (52.5)	1,647 (51.2)
Male	7,420 (45.9)	3,410 (45.7)	4,790 (47.4)	1,571 (48.8)
Unknown/missing	14 (0.1)	8 (0.1)	8 (0.1)	2 (0.1)
Region, n (%)^b
North Central	3,723 (23.0)	1,666 (22.3)	2,367 (23.4)	719 (22.3)
Northeast	3,108 (19.2)	1,408 (18.9)	1,882 (18.6)	552 (17.1)
South	7,608 (47.1)	3,506 (47.0)	4,737 (46.9)	1,528 (47.5)
West	1,679 (10.4)	849 (11.4)	1,084 (10.7)	408 (12.7)
Unknown/missing	51 (0.3)	35 (0.47)	30 (0.3)	13 (0.4)
Health care plan type, n (%)^b
Comprehensive	861 (5.3)	296 (4.0)	531 (5.3)	147 (4.6)
EPO	131 (0.8)	57 (0.8)	77 (0.8)	27 (0.8)
HMO	1,605 (9.9)	894 (12.0)	992 (9.8)	383 (11.9)
POS	1,294 (8.0)	765 (10.3)	782 (7.7)	337 (10.5)
PPO	9,087 (56.2)	4,124 (55.3)	5,721 (56.6)	1,753 (54.4)
POS with capitation	184 (1.1)	93 (1.3)	112 (1.1)	34 (1.1)
CDHP	1,581 (9.8)	518 (6.9)	989 (9.8)	223 (6.9)
Other/missing	1,426 (8.8)	717 (9.6)	896 (8.9)	316 (9.8)
Duration of follow-up, mean (SD) months^b	14.2 (12.0)	14.4 (12.2)	13.2 (11.3)	10.9 (10.0)

Abbreviations. NGS, next generation sequencing; SD, standard deviation; EPO, exclusive provider organization; HMO, health maintenance organization; POS, point-of-service; PPO, preferred provider organization; CDHP, consumer directed health plan.

^aPercent of all patients.

^bPercent/mean of column.

Table 3. Characteristics of patients with thyroid cancer, with and without biomarker testing codes.

	Thyroid cancer N = 36,867		Metastatic thyroid cancer N = 2,241
	With biomarker codes	No biomarker codes	With biomarker codes	No biomarker codes
Number of patients, n (%)^a	6,727 (18.2)	30,140 (81.8)	948 (42.3)	1,293 (57.7)
At least one comprehensive NGS biomarker code, n (%)^b	122 (1.8)	0 (0.0)	49 (5.2)	0 (0.0)
Year of initial diagnosis, n (%)^b
2015	1,739 (25.9)	6,623 (22.0)	239 (25.2)	354 (27.4)
2016	1,631 (24.3)	6,586 (21.9)	244 (25.7)	276 (21.4)
2017	1,359 (20.2)	6,913 (22.9)	185 (19.5)	257 (19.9)
2018	1,349 (20.1)	7,041 (23.4)	193 (20.4)	287 (22.2)
2019	649 (9.7)	2,977 (9.9)	87 (9.28)	119 (9.2)
Age, mean (SD) years^b	46.47 (11.6)	45.39 (11.5)	48.50 (11.8)	44.10 (13.1)
Gender, n (%)
Female	5,076 (75.5)	23,751 (78.8)	582 (61.4)	876 (67.8)
Male	1,642 (24.4)	6,370 (21.1)	363 (38.3)	417 (32.3)
Unknown/missing	9 (0.1)	19 (0.1)	3 (0.3)	0 (0.0)
Region, n (%)^b
North Central	1,172 (17.4)	5,707 (18.9)	187 (19.7)	240 (18.6)
Northeast	1,724 (25.6)	6,531 (21.7)	216 (22.8)	304 (23.5)
South	2,787 (41.4)	12,522 (41.6)	378 (39.9)	529 (40.9)
West	1,010 (15.0)	5,232 (17.4)	163 (17.2)	214 (16.6)
Unknown/missing	34 (0.5)	148 (0.5)	4 (0.4)	6 (0.5)
Health care plan type, n (%)^b
Comprehensive	151 (2.2)	599 (2.0)	27 (2.9)	15 (1.2)
EPO	66 (1.0)	303 (1.0)	9 (1.0)	20 (1.6)
HMO	717 (10.7)	3,326 (11.0)	104 (11.0)	138 (10.7)
POS	631 (9.4)	3,092 (10.3)	81 (8.5)	127 (9.8)
PPO	3,575 (53.1)	16,360 (54.3)	500 (52.7)	723 (55.9)
POS with capitation	108 (1.6)	367 (1.2)	17 (1.8)	18 (1.4)
CDHP	657 (9.8)	2,490 (8.3)	93 (9.8)	98 (7.6)
Other/missing	822 (12.2)	3,603 (12.0)	117 (12.3)	154 (11.9)
Duration of follow-up, mean (SD) months^b	24.5 (15.2)	22.4 (14.1)	23.1 (15.4)	21.6 (14.5)

Abbreviations. NGS, next generation sequencing; SD, standard deviation; EPO, exclusive provider organization; HMO, health maintenance organization; POS, point-of-service; PPO, preferred provider organization; CDHP, consumer directed health plan.

^aPercent of all patients.

^bPercent/mean of column.

Table 4. Median (interquartile range, IQR) and mean (standard deviation, SD) lifetime per-patient payer costs of biomarker testing, by payer and tumor type.

Lifetime payer costs among patients with at least one biomarker code Median (Q1, Q3) Mean (SD)	Lung cancer N = 15,397^a	Metastatic lung cancer N = 9,598^a	Thyroid cancer N = 6,128^a	Metastatic thyroid cancer N = 884^a
Lifetime payer costs^b	$393.80 ($179, $892) $846.40 ($1,531.00)	$461.50 ($207, $1,032) $957.98 ($1,649.60)	$147.60 ($76, $323) $364.02 ($791.07)	$231.80 ($107, $580) $607.82 ($1,363.40)
Comprehensive	$338.80 ($166, $683) $664.97 ($1,295.70)	$388.20 ($193, $789) $769.39 ($1,564.20)	$169.30 ($84, $379) $490.95 ($2,135.40)	$383.00 ($178, $837) $1,474.80 ($4,771.70)
EPO	$443.10 ($224, $769) $741.31 ($1,040.90)	$475.20 ($234, $769) $835.94 ($1,249.90)	$210.20 ($97, $407) $439.10 ($847.77)	$399.00 ($233, $834) $569.84 ($552.82)
HMO	$359.70 ($175, $849) $746.00 ($1,287.40)	$416.90 ($200, $1,017) $853.16 ($1,475.60)	$146.30 ($74, $339) $395.44 ($775.79)	$165.00 ($93, $638) $625.89 ($1,192.20)
POS	$391.20 ($173, $839) $734.58 ($1,078.10)	$445.40 ($207, $948) $831.61 ($1,207.80)	$165.50 ($92, $331) $359.14 ($797.25)	$242.50 ($125, $433) $691.08 ($1,784.30)
PPO	$407.70 ($182, $932) $904.48 ($1,702.40)	$477.10 ($209, $1,076) $1,019.17 ($1,807.60)	$148.40 ($77, $323) $369.05 ($751.38)	$232.60 ($109, $578) $574.08 ($1,083.10)
POS with capitation	$316.50 ($180, $673) $591.80 ($893.97)	$331.50 ($186, $750) $670.89 ($1,066.80)	$177.90 ($90, $372) $273.20 ($266.82)	$304.10 ($178, $550) $428.78 ($410.07)
CDHP	$397.90 ($169, $896) $868.51 ($1,455.40)	$499.70 ($213, $1,076) $1,022.18 ($1,592.20)	$128.20 ($65, $311) $335.60 ($659.73)	$297.60 ($106, $727) $621.63 ($854.79)
Lifetime patient out-of-pocket costs Median (Q1, Q3) Mean (SD)	$0.00 ($0, $47) $122.46 ($501.06)	$0.00 ($0, $58) $142.58 ($541.22)	$0.00 ($0, $31) $48.78 ($186.61)	$0.00 ($0, $30) $62.69 ($265.41)
Comprehensive	$0.00 ($0, $0) $36.21 ($202.52)	$0.00 ($0, $0) $39.66 ($224.88)	$0.00 ($0, $20) $19.32 ($38.01)	$0.00 ($0, $0) $17.00 ($37.78)
EPO	$0.00 ($0, $0) $30.30 ($203.15)	$0.00 ($0, $13) $44.03 ($265.36)	$0.00 ($0, $12) $22.75 ($60.21)	$0.00 ($0, $58) $52.26 ($83.89)
HMO	$0.00 ($0, $0) $53.57 ($411.27)	$0.00 ($0, $0) $64.11 ($468.08)	$0.00 ($0, $7) $25.90 ($139.75)	$0.00 ($0, $4) $35.73 ($134.41)
POS	$0.00 ($0, $0) $84.41 ($290.74)	$0.00 ($0, $45) $99.29 ($315.86)	$0.00 ($0, $23) $30.57 ($98.73)	$0.00 ($0, $32) $41.23 ($97.87)
PPO	$0.00 ($0, $57) $129.47 ($519.58)	$0.00 ($0, $68) $150.44 ($551.16)	$0.00 ($0, $33) $49.66 ($190.71)	$0.00 ($0, $30) $60.17 ($274.78)
POS with capitation	$0.00 ($0, $0) $12.62 ($63.22)	$0.00 ($0, $0) $15.89 ($77.70)	$0.00 ($0, $0) $4.47 ($18.69)	$0.00 ($0, $0) $4.88 ($19.54)
CDHP	$0.00 ($0, $109) $195.98 ($609.17)	$10.40 ($0, $133) $242.53 ($711.93)	$11.80 ($0, $55) $78.68 ($288.25)	$0.00 ($0, $55) $117.05 ($446.85)
Lifetime costs of all biomarker testing among patients with at least one comprehensive/ NGS-based code Median (Q1, Q3) Mean (SD)	Lung cancer N = 517^a	Metastatic lung cancer N = 370^a	Thyroid cancer N = 57^a	Metastatic thyroid cancer N = 22^a
Lifetime payer costs	$2,302.90 ($402, $4,191) $2,614.52 ($2,429.80)	2,333.90 ($421, $4,283) $2,636.44 ($2,336.20)	$1,469.40 ($486, $2,928) $1,761.65 ($1,385.60)	$1,647.80 ($479, $3,018) $1,923.37 ($1,651.70)
Lifetime patient out-of-pocket costs	$0.00 ($0, $33) $476.62 ($1,279.10)	$0.00 ($0, $22) $472.92 ($1,143.60)	$0.00 ($0, $586) $480.80 ($868.63)	$0.00 ($0, $586) $557.12 ($1,103.10)

Abbreviations. min, minimum; max, maximum; EPO, exclusive provider organization; HMO, health maintenance organization; POS, point-of-service; PPO, preferred provider organization; CDHP, consumer directed health plan.

^aN of patients with biomarker codes identifiable within claims; ^bmissing/other payer type not shown.

Table 5. Median and interquartile range (IQR) costs of single-gene and comprehensive/NGS-based testing codes.

Single gene biomarker codes			Comprehensive/next generation sequencing (NGS) codes
Code	Number of claims with code observed	Median (IQR) payer costs)	Code	Number of claims with code observed	Median (IQR) payer cost
81235	3,048	$249.85 ($0, $7,218)	81445	255	$549.98 ($0, $14,487)
81288	7	$324.90 ($61, $439)	81450	9	$786.19 ($463, $9,357)
81311	805	$226.46 ($0, $1,944)	81455	138	$3,976.50 ($0, $13,217)
81301	246	$267.24 ($0, $13,023)	0022 U	3	$1,097.21 ($395, $2,292)
81210	1,701	$122.04 ($0, $8,850)	0037 U	186	$3,145.67 ($0, $6,007)
81275	1,517	$157.93 ($0, $5,519)	0013 U	0	–
81276	622	$144.21 ($0, $1,232)	0012 U	0	–
88342	31,138	$66.03 ($0, $4,291)	0026 U	16	$2,928.10 ($0, $5,962)
88341	27,019	$93.12 ($0, $6,308)	0179 U	0	–
88344	920	$68.11 ($0, $2,875)	0204 U	0	–
88364	122	$64.11 ($0, $520)	0208 U	0	–
88365	268	$93.04 ($0, $725)	0048 U	0	–
88360	6,339	$96.85 ($0, $6,154)	0047 U	1	$3,222.94 (–)
88377	3,697	$192.16 ($0, $7,286)
88374	1,127	$150.40 ($0, $4,341)
88367	58	$108.78 ($0, $847)
88368	366	$133.43 ($0, $2,103)
88373	21	$56.25 ($0, $1,213)
88369	116	$55.98 ($0, $1,523)
88366	69	$127.67 ($0, $1,475)
88365	268	$93.04 ($0, $725)
81402	949	$97.98 ($0, $1,426)
81403	1,862	$93.90 ($0, $7,239)
81404	1,909	$181.62 ($0, $7,141)
81519	78	$4,008.94 ($317, $4,903)
81228	1	$1,016.70 (–)
81229	12	$1,727.58 ($256, $5,790)
0018 U	2	$2,047 ($1,807, $2,288)

Data availability statement

Data used in this study were supplied by International Business Machines Corporation under license for scientific research at Eli Lilly and Company. Data are available for research purposes by licensing directly from IBM, Inc. (www.ibm.com/products/marketscan-research-databases).

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations

A poster containing an earlier version of data from this study was presented at ISPOR International Conference (Washington, DC) on 15–18 May 2022.