Utilization of genetic tests: analysis of gene-specific billing in Medicare claims data
| Autor: | Nicole M. Coomer, John Kautter, Julie Lynch, Brygida Berse, Muin J. Khoury, W. David Dotson |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Male medicine.medical_specialty Lung Neoplasms Cross-sectional study Medicare 03 medical and health sciences 0302 clinical medicine Tier 2 network medicine Biomarkers Tumor Humans Genetic Predisposition to Disease Genetic Testing Precision Medicine health care economics and organizations Genetics (clinical) Genetic testing Aged Retrospective Studies Insurance Claim Reporting medicine.diagnostic_test business.industry Retrospective cohort study Middle Aged Precision medicine United States Test (assessment) 030104 developmental biology Cross-Sectional Studies 030220 oncology & carcinogenesis Family medicine Female Personalized medicine Diagnosis code business |
| Zdroj: | Genetics in medicine : official journal of the American College of Medical Genetics. 19(8) |
| ISSN: | 1530-0366 |
| Popis: | We examined the utilization of precision medicine tests among Medicare beneficiaries through analysis of gene-specific tier 1 and 2 billing codes developed by the American Medical Association in 2012. We conducted a retrospective cross-sectional study. The primary source of data was 2013 Medicare 100% fee-for-service claims. We identified claims billed for each laboratory test, the number of patients tested, expenditures, and the diagnostic codes indicated for testing. We analyzed variations in testing by patient demographics and region of the country. Pharmacogenetic tests were billed most frequently, accounting for 48% of the expenditures for new codes. The most common indications for testing were breast cancer, long-term use of medications, and disorders of lipid metabolism. There was underutilization of guideline-recommended tumor mutation tests (e.g., epidermal growth factor receptor) and substantial overutilization of a test discouraged by guidelines (methylenetetrahydrofolate reductase). Methodology-based tier 2 codes represented 15% of all claims billed with the new codes. The highest rate of testing per beneficiary was in Mississippi and the lowest rate was in Alaska. Gene-specific billing codes significantly improved our ability to conduct population-level research of precision medicine. Analysis of these data in conjunction with clinical records should be conducted to validate findings. Genet Med advance online publication 26 January 2017 |
| Databáze: | OpenAIRE |
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