In a study reported in JCO Oncology Practice, Emily H. Castellanos, MD, MPH, and colleagues found that the requirement for Medicare Oncology Care Model (OCM) practices to report biomarker testing of patients with advanced non–small cell lung cancer (NSCLC) has not substantially altered the proportions of patients who received either testing or biomarker-guided therapy in OCM vs non-OCM practices.
Emily H. Castellanos, MD, MPH
Study Details
As of October 2017, practices participating in OCM were required to report biomarker testing of patients with advanced NSCLC. The current analysis included data from 8,151 patients treated at 45 OCM practices and 5,897 patients treated at 105 non-OCM practices who were diagnosed with advanced NSCLC between January 2011 and November 2018. An adjusted difference-in-differences logistic regression analysis was used to compare changes in biomarker testing rates for EGFR, ROS1, and ALK aberrations and receipt of biomarker-guided therapy between patients in OCM vs non-OCM practices before and after OCM implementation. The period from January 1, 2016, to September 30, 2017 (including the date of the start of the OCM program in July 2016) was considered an implementation washout period, with differences being assessed for the preperiod (January 1, 2011–December 31, 2015) and the postperiod (October 1, 2017–November 30, 2018).
Key Findings
The overall unadjusted rates for biomarker testing increased between 2011 and 2018 from 55.5% to 71.6% in OCM practices and from 55.2% to 69.7% in non-OCM practices. No significant difference was observed in the preperiod (OR = 1.01, 95% confidence interval [CI] = 0.93–1.11) or in the postperiod (OR = 1.10, 95% CI = 0.91–1.33).
The overall unadjusted rates for receipt of biomarker-guided therapy increased over the study period from 89.9% to 94.6% in OCM practices and from 90.1% to 95.2% in non-OCM practices. No significant difference was observed in the preperiod (OR = 0.96, 95% CI = 0.79–1.18) or the postperiod (OR = 0.89, 95% CI = 0.54–1.44).
In the adjusted difference-in-differences model, the rates of biomarker testing (odds ratio [OR] = 1.09, P = .45) and receipt of biomarker-guided therapy (OR = 0.87, P = .58) did not significantly differ for OCM vs non-OCM practices.
The investigators concluded, “OCM biomarker documentation and reporting requirements did not appear to increase the proportions of patients with [advanced] NSCLC who underwent testing or who received biomarker-guided therapy in OCM vs non-OCM practices.”
Dr. Castellanos, of Flatiron Health, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by Flatiron Health, an independent subsidiary of the Roche Group. For full disclosures of the study authors, visit ascopubs.org.
