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

Figures & data

Table 1. Baseline characteristics.

	aNSCLC			aMelanoma			mCRC
	MGPT	Non-MGPT	Overall	MGPT	Non-MGPT	Overall	MGPT	Non-MGPT	Overall
	(n = 273)	(n = 273)	(n = 546)	(n = 56)	(n = 56)	(n = 112)	(n = 95)	(n = 95)	(n = 190)
Age (years)
Mean (SD)	59.8 (7.17)	58.9 (8.33)	59.3 (7.78)	52.8 (11.3)	50.3 (10.8)	51.6 (11.1)	54.3 (8.30)	53.5 (10.1)	53.9 (9.23)
Median (min, max)	60.0 [36.0, 80.0]	60.0 [19.0, 80.0]	60.0 [19.0, 80.0]	54.0 [24.0, 74.0]	50.5 [5.0, 67.0]	53.0 [5.0, 74.0]	56.0 [25.0, 70.0]	55.0 [2.00, 72.0]	55.5 [2.00, 72.0]
Gender
Female	141 (51.6%)	147 (53.8%)	288 (52.7%)	19 (33.9%)	11 (19.6%)	30 (26.8%)	31 (32.6%)	36 (37.9%)	67 (35.3%)
Male	132 (48.4%)	126 (46.2%)	258 (47.3%)	37 (66.1%)	45 (80.4%)	82 (73.2%)	64 (67.4%)	59 (62.1%)	123 (64.7%)
Region
East	50 (18.3%)	42 (15.4%)	92 (16.8%)	13 (23.2%)	13 (23.2%)	26 (23.2%)	18 (18.9%)	12 (12.6%)	30 (15.8%)
Midwest	91 (33.3%)	99 (36.3%)	190 (34.8%)	18 (32.1%)	17 (30.4%)	35 (31.2%)	29 (30.5%)	17 (17.9%)	46 (24.2%)
South	106 (38.8%)	109 (39.9%)	215 (39.4%)	16 (28.6%)	15 (26.8%)	31 (27.7%)	39 (41.1%)	52 (54.7%)	91 (47.9%)
West	26 (9.5%)	23 (8.4%)	49 (9.0%)	9 (16.1%)	11 (19.6%)	20 (17.9%)	9 (9.5%)	14 (14.7%)	23 (12.1%)
Plan type
Indemnity/traditional	9 (3.3%)	5 (1.8%)	14 (2.6%)	6 (10.7%)	2 (3.6%)	8 (7.1%)	3 (3.2%)	1 (1.1%)	4 (2.1%)
Point of service	20 (7.3%)	15 (5.5%)	35 (6.4%)	5 (8.9%)	2 (3.6%)	7 (6.2%)	5 (5.3%)	6 (6.3%)	11 (5.8%)
Preferred provider organization	242 (88.6%)	249 (91.2%)	491 (89.9%)	45 (80.4%)	51 (91.1%)	96 (85.7%)	86 (90.5%)	88 (92.6%)	174 (91.6%)
Unknown/missing	2 (0.7%)	4 (1.5%)	6 (1.1%)	0 (0%)	1 (1.8%)	1 (0.9%)	1 (1.1%)	0 (0%)	1 (0.5%)
Follow-up time (months)
Mean (SD)	12.2 (10.0)	12.2 (10.0)	12.2 (10.0)	17.9 (12.1)	17.6 (12.9)	17.8 (12.4)	15.6 (12.3)	14.0 (10.3)	14.8 (11.4)
Median (min., max.)	8.7 [0.4, 47.7]	8.7 [0.4, 47.7]	8.7 [0.4, 47.7]	19.5 [1.00, 47.0]	15.5 [1.00, 56.0]	17.0 [1.00, 56.0]	13.0 [0, 49.0]	13.0 [0, 45.0]	13.0 [0, 49.0]
Charlson Comorbidity Index
Mean (SD)	7.21 (3.31)	7.17 (3.28)	7.19 (3.29)	8.36 (2.67)	7.77 (2.45)	8.06 (2.57)	8.99 (2.08)	9.37 (1.96)	9.18 (2.02)
Median (min, max)	9.00 [3.00, 19.0]	9.00 [3.00, 16.0]	9.00 [3.00, 19.0]	9.00 [3.00, 16.0]	9.00 [3.00, 13.0]	9.00 [3.00, 16.0]	9.00 [3.00, 13.0]	10.0 [3.00, 14.0]	9.00 [3.00, 14.0]
Baseline costs ($1000s)
Mean (SD)	26.4 (24.9)	26.9 (30.6)	26.7 (27.9)	24.5 (30.7)	22.4 (29.7)	23.4 (30.1)	73.6 (65.4)	97.3 (85.5)	85.5 (76.9)
Median (min, max)	19.0 [0.00, 153]	17.0 [0.00, 229]	18.0 [0.00, 229]	14.0 [1.00, 179]	10.0 [0.00, 113]	11.0 [0.00, 179]	65.0 [3.00, 418]	78.0 [1.00, 439]	71.0 [1.00, 439]

aMelanoma: Advanced melanoma; aNSCLC: Advanced non-small-cell lung cancer; mCRC: Metastatic colorectal cancer; MGPT: Multigene panel test; SD: Standard deviation.

Table 2. Total costs for patients with multigene panel test claims versus without multigene panel test claims.

	aNSCLC		aMelanoma		mCRC
	MGPT tested (n = 273)	Non-MGPT tested (n = 273)	MGPT tested (n = 56)	Non-MGPT tested (n = 56)	MGPT tested (n = 95)	Non-MGPT tested (n = 95)
Total mean costs up to 1 year post index (US$, SD)	198 271 (150 411)	197 147 (156 167)	243 204 (170 039)	227 805 (215 747)	163 112 (123 664)	164 300 (155 520)
Total medical costs	185 200 (150 259)	180 620 (154 960)	228 323 (163 648)	214 691 (212 854)	153 960 (121 999)	154 177 (155 912)
Inpatient	47 903 (72 743)	53 008 (71 970)	29 947 (55 513)	46 856 (84 624)	31 957 (46 048)^†	27 490 (57 133)
Outpatient	137 297 (133 618)	127 612 (140 431)	198 376 (162 513)	167 835 (189 068)	122 008 (104 811)	126 687 (138 547)
Cancer-treatment related	60 747 (93 706)	55 305 (97 944)	136 409 (144 188)^†	109 369 (173 391)	58 168 (67 689)	65 353 (80 865)
MGPT related costs	1076 (2126)^‡	0 (0)	1243 (2292)^‡	0 (0)	891 (2007)^‡	0 (0)
Total pharmacy costs	13 071 (33 384)	16 527 (34 736)	14 881 (26 188)	13 113 (27 971)	9152 (17 041)	10 124 (16 842)

Comparisons between MGPT tested and non-MGPT tested not significant (p > 0.05) unless indicated:

† p < 0.05.

‡ p < 0.01.

aMelanoma: Advanced melanoma; aNSCLC: Advanced non-small-cell lung cancer; mCRC: Metastatic colorectal cancer; MGPT: Multigene panel test; SD: Standard deviation.

Table 3. Base case estimates for impact on insurance premiums for a hypothetical 1 million member commercial health plan.

	aNSCLC	aMelanoma	mCRC	Overall
Number of plan members with tumor	142	59	235	436
Number of plan members MGPT tested (scenario without MGPT coverage)	82	12	94	188
Number of plan members MGPT tested (scenario with MGPT coverage)	86	12	99	198
Additional total cost for MGPT coverage for the year (US$)	93 248	23 753	78 170	195 171
Per member per month ($)	0.008	0.002	0.007	0.016
Individual and small employer plans (MLR = 80%)
Total change in premium per enrollee per month ($)	0.019	0.005	0.016	0.040
Change in employee contribution to premium per enrollee per month ($)	0.005	0.001	0.004	0.010
Change in employer contribution to premium per enrollee per month ($)	0.014	0.004	0.012	0.030
Change in plan paid per enrollee per month ($)	0.015	0.004	0.013	0.032
Change in admin expense/profit load per enrollee per month ($)	0.004	0.001	0.003	0.008
Large self-funded plans (MLR = 85%)
Total change in premium per enrollee per month ($)	0.018	0.005	0.015	0.037
Change in employee contribution to premium per enrollee per month ($)	0.004	0.001	0.004	0.009
Change in employer contribution to premium per enrollee per month ($)	0.013	0.003	0.011	0.028
Change in plan paid per enrollee per month ($)	0.015	0.004	0.013	0.032
Change in admin expense/profit load per enrollee per month ($)	0.003	0.001	0.002	0.006
Large fully insured plans (MLR = 97%)
Total change in premium per enrollee per month ($)	0.016	0.004	0.013	0.033
Change in employee contribution to premium per enrollee per month ($)	0.004	0.001	0.003	0.008
Change in employer contribution to premium per enrollee per month ($)	0.012	0.003	0.010	0.025
Change in plan paid per enrollee per month ($)	0.015	0.004	0.013	0.032
Change in admin expense/profit load per enrollee per month ($)	0.000	0.000	0.000	0.001

aMelanoma: Advanced melanoma; aNSCLC: Advanced non-small-cell lung cancer; mCRC: Metastatic colorectal cancer; MGPT: Multigene panel test; MLR: Medical loss ratio.

Figure 1. One-way sensitivity analysis: assessment of varying the value of individual model inputs on the change in insurance premiums.

aMelanoma: Advanced melanoma; aNSCLC: Advanced non-small-cell lung cancer; mCRC: Metastatic colorectal cancer; MGPT: Multigene panel test.

Table 4. Two-way sensitivity analysis: assessment of varying multigene panel test utilization and costs simultaneously on the change in insurance premiums.

*Base case.

aMelanoma: Advanced melanoma; aNSCLC: Advanced non-small-cell lung cancer; mCRC: Metastatic colorectal cancer; MGPT: Multigene panel test.