Dalal Anand A, Guerin Annie, Mutebi Alex, Culver Kenneth W
a Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
b Analysis Group, Inc. , Montréal , Québec , Canada.
J Med Econ. 2018 Jul;21(7):649-655. doi: 10.1080/13696998.2018.1450261. Epub 2018 Mar 26.
To assess the time to BRAF testing, compare the characteristics of tested vs not-tested patients, and describe the costs for sequential vs next-generation sequencing (NGS) BRAF testing.
Patients diagnosed with lung cancer after December 1, 2013 were identified from two US claims databases; their characteristics were assessed during the 12 months before diagnosis (index date). Testing modalities were analyzed from the index date to end of continuous health plan enrollment or data availability (December 2015), based on combinations of Current Procedural Terminology (CPT) procedure codes. Time to BRAF testing was assessed using Kaplan-Meier analysis. Costs were analyzed from a payer's perspective.
A total of 28,011 patients newly-diagnosed with lung cancer were identified. Of them, 1,260 (4.5%) were tested for BRAF: 3.2% and 4.2% were tested at 6 and 12 months, respectively, after the index date. Compared to non-tested patients, tested patients were younger (58.3 vs 65.3 years; p < .001), had a lower Charlson Comorbidity Index (2.8 vs 2.9; p = .005), and a higher proportion had metastases (70.9% vs 43.4%; p < .001). In 76.0% of cases, BRAF was tested along with KRAS. BRAF was tested using NGS in 6.6% of cases. The average reimbursed amounts for the 10 most common CPT code combinations were $207-$2,074. Using the average costs of individual mutation tests, the total cost of sequential testing comprising KRAS, EGFR, ALK, ROS1, and BRAF tests was $3,763 ($464, $696, $1,070, $1,127, and $406, respectively), that of NGS was $2,860.
Claims data did not include BRAF test results.
Among patients newly-diagnosed with lung cancer, 4.5% were tested for BRAF. Tested patients were younger and had a lower comorbidity burden, but more advanced disease. While reimbursed amounts varied greatly based on combinations of testing procedures, NGS testing was associated with cost savings compared to sequential testing of individual mutations.
评估进行BRAF检测的时间，比较接受检测与未接受检测患者的特征，并描述序贯检测与新一代测序（NGS）BRAF检测的成本。
从两个美国索赔数据库中识别出2013年12月1日之后被诊断为肺癌的患者；在诊断前的12个月（索引日期）评估他们的特征。根据当前程序术语（CPT）程序代码的组合，从索引日期到持续健康计划登记结束或数据可用（2015年12月）分析检测方式。使用Kaplan-Meier分析评估BRAF检测的时间。从支付方的角度分析成本。
共识别出28,011例新诊断为肺癌的患者。其中，1260例（4.5%）接受了BRAF检测：分别在索引日期后的6个月和12个月时，有3.2%和4.2%的患者接受了检测。与未接受检测的患者相比，接受检测的患者更年轻（58.3岁对65.3岁；p <.001），Charlson合并症指数更低（2.8对2.9；p =.005），且转移比例更高（70.9%对43.4%；p <.001）。在76.0%的病例中，BRAF与KRAS一起检测。6.6%的病例使用NGS检测BRAF。10种最常见的CPT代码组合的平均报销金额为207美元至2074美元。使用单个突变检测的平均成本，包括KRAS、EGFR、ALK、ROS1和BRAF检测的序贯检测总成本为3763美元（分别为464美元、696美元、1070美元、1127美元和406美元），NGS检测的成本为2860美元。
索赔数据不包括BRAF检测结果。
在新诊断为肺癌的患者中，4.5%接受了BRAF检测。接受检测的患者更年轻，合并症负担更低，但疾病更晚期。虽然报销金额因检测程序组合而异，但与单个突变的序贯检测相比，NGS检测可节省成本。
