Analysis of reimbursement (R) for next generation sequencing (NGS) on patients' tumors in the context of a personalized medicine program

Autor: Thomas D. Brown, Charles W. Drescher, Scott D. Ramsey, Tara Benkers, J. David Beatty, Philip J. Gold, Anna B. Berry, Madeleine Brindle, Xiaoyu Liu, Nina Varghis, James M. Scanlan, George Richard Birchfield, Tanya A. Wahl, John M. Pagel, Kathleen N. Fondren, Lauren K. Summers, Mariko Tameishi, James W.T. Yates, Shlece Alexander, David Edwin Dong
Rok vydání: 2017
Předmět:
Zdroj: Journal of Clinical Oncology. 35:6506-6506
ISSN: 1527-7755
0732-183X
DOI: 10.1200/jco.2017.35.15_suppl.6506
Popis: 6506 Background: R policies for NGS testing vary widely among private and public insurers. While drug costs are the greatest challenge in personalized or precision medicine, cost and R are substantial barriers to genomic profiling with NGS. We examined variation in coverage and R for a cohort of cancer patients (pts) treated at a tertiary oncology center. Methods: An Institutional Review Board approved prospective registration protocol was activated with the objective of establishing a centralized longitudinal clinical, molecular phenotypic, and research data repository for pts diagnosed with cancer. Based on provider assessment of medical necessity, mutations in 68 cancer associated genes were analyzed. Evaluation of R for NGS was performed from Sept, 2014 through Jan, 2017, with use of CPT code 81455. R was analyzed based on: payer type; pt age; localized vs. metastatic disease; and actionability of data. Results: 588 pts with evaluable analytic cases, and NGS testing, with R results shown in the table below. For groups with >= 10 pts: R frequency was highest in managed care programs, either private or Medicare, and least frequent in non-HMO Medicare (p= 60 years; p
Databáze: OpenAIRE
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