A retrospective cohort study reported in JAMA Network Open revealed that biomarker testing rates among patients with advanced cancer have increased over time but remain suboptimal, despite established guideline recommendations and growing insurance coverage for testing. DaCosta Byfield et al noted that interventions to further improve access may enhance patient outcomes.
“There were no differences in costs during first-line therapy between patients who received comprehensive genomic profiling testing vs patients who received non-comprehensive genomic profiling testing across evaluated cancer types,” the investigators added. “Although inadequate commercial insurance coverage is often cited as a barrier to comprehensive genomic profiling, testing rates in Medicare Advantage beneficiaries were generally lower or comparable to those in commercial populations despite comprehensive genomic profiling coverage.”
Study Details
Using the de-identified Optum Labs Data Warehouse database, the investigators identified 26,311 patients who were diagnosed with advanced cancer (ie, breast, colorectal, gastric, non–small cell lung [NSCLC], ovarian, and pancreatic) between January 2018 and January 2022. They must have been continuously enrolled in a commercial (30%) or Medicare Advantage (70%) health plan for 12 months before and 6 months after their first advanced cancer diagnosis.
The main outcomes and measures included evidence of biomarker testing; receipt of targeted therapy in the first-line setting; and per-patient, per-month costs during first-line therapy.
Key Findings
The investigators reported a “suboptimal” molecular testing rate of 35%; however, the rate was found to increase over time for most cancer types (from 32% in 2018 to 39% in 2021–2022). Patients with NSCLC and colorectal cancer who underwent comprehensive genomic profiling (odds ratio [OR] = 1.57, 95% confidence interval [CI] = 1.31–1.90; P < .001) seemed to be more likely to receive targeted therapy compared with those who underwent non-comprehensive testing (OR = 2.34, 95% CI = 1.58–3.47; P < .001).
Costs among patients who underwent comprehensive vs non-comprehensive genomic profiling did not appear to differ significantly. The investigators reported a cost ratio of 1.03 (95% CI = 0.91–1.17; P = .63) for breast cancer; 0.98 (95% CI = 0.89–1.09; P = .71) for colorectal cancer; 1.10 (95% CI = 0.87–1.40; P = .42) for gastric cancer; 1.06 (95% CI = 1.00–1.13; P = .054) for NSCLC; 0.94 (95% CI = 0.76–1.15; P = .55) for ovarian cancer; and 1.00 (95% CI = 0.83–1.21; P = .98) for pancreatic cancer.
The investigators concluded: “Interventions to improve biomarker testing are needed, especially as more targeted therapies are developed for all cancer types. Given our findings that comprehensive genomic profiling testing does not significantly increase total all-cause costs and the potential benefits of comprehensive genomic profiling over non-comprehensive genomic profiling approaches, including optimization of tissue stewardship, detection of genomic signatures (eg, tumor mutational burden), and potential identification for trial eligibility, the increased adoption of comprehensive genomic profiling that includes assessment of all guideline-recommended biomarkers may offer opportunities for improved outcomes.”
Stacey DaCosta Byfield, PhD, MPH, of Optum, Eden Prairie, Minnesota, is the corresponding author of the JAMA Network Open article.
Disclosure: Illumina Inc provided funding for this study. The funder (Illumina) contracted with Optum to design and conduct the study. For full disclosures of the study authors, visit jamanetwork.com.