Using real-world evidence to evaluate broad panel vs. sequential single and narrow panel sequencing in members with non-small cell lung cancer (NSCLC).
Authors: Byrd Brooke , Hospodar Alexa , Cullum Bob , Hastings Kevin , Teschner Taylor , Brown Trish , Perez Lady , Reddy Shirisha , Belinson Suzanne , Schulin Joseff , Klein Ira , Rivers Zach , Hovanec Emma , Mergler Patrick , Avalos-Reyes Elisea , Warde Prem R. , Coelho Vanessa , Verbrugge Dorothea J. , Brito Rogelio A. , Johnson Kjel Andrew 
Published: June 2023

e18892

Background: The clinical benefits of biomarker testing for patients with non-small cell lung cancer (NSCLC) are substantial, as increased use of appropriate targeted therapies is associated with improved survival rates. Next generation sequencing (NGS) testing has become increasingly important as it enables the identification of multiple biomarkers simultaneously and efficiently while minimizing the number of biopsies required. The purpose of this study is to assess the total cost of care (TCOC) of broad panel sequencing (BPS) ( > 5 genes) and narrow panel sequencing (NPS) in NSCLC patients. Methods: This study evaluated members with a NSCLC diagnosis undergoing biomarker testing insured by a large commercial fully-insured and Medicare health plan in the United States from January 1, 2021, to December 31, 2021. Due to the complex and inconsistent practices of billing among lab vendors, claims were analyzed and classified using supervised machine learning models to identify the correct test category from Concert Genetics (CG) test taxonomy. Test categories within CG test taxonomy were then mapped to the higher-level classifications of BPS and NPS. CG’s BPS categories included: Cell-Free Circulating Tumor DNA Lung Cancer Panel Tests, Cell-Free DNA Cancer Profiling Panel Tests (5-50 genes), Cell-Free DNA Cancer Profiling Panel Tests (≥ 51 genes), Lung Cancer Diagnostic Algorithmic Tests, Lung Cancer Panel Tests, Tumor-Type Agnostic Molecular Solid Tumor Profiling Panel Tests (≥ 51 genes), Tumor-Type Agnostic Solid Tumor Molecular Profiling Panel Tests (5-50 genes), Tumor-Type Agnostic Solid Tumor Molecular Profiling Panels Tests with IHC and Cytogenetic Analyses. Claims matched to other categories were considered NPS. No price concessions were allowed for external vendors to account for cost differences when evaluating TCOC. Results: In this study, 356 members were evaluated; members were on average 72.5 years (std = 7.5), predominately male (n = 199; 55.9%) with Medicare (n = 332; 93.3%) coverage. These members underwent BPS testing (n = 151; 42.4%) and were NCCN treatment compliant (n = 221; 62.1%). The most common comorbidities identified for these members were hyperlipidemia (n = 286; 80.3%) and hypertension (n = 281; 78.9%). After adjusting for age, gender, and insurance type, the TCOC for patients undergoing BPS testing was $1,750 more than NPS testing (p = 0.03). Conclusions: There was a difference in TCOC between BPS and NPS testing. Standardized billing processes need to be implemented to evaluate clinical outcomes to adequately compare their clinical utility and identify the influence of explanatory variables on costs.