Genomic Testing: Oncologists' Financial Concerns
Dr Maurie Markman discusses genomic testing and the associated financial considerations.
https://www.medscape.com/viewarticle/...
-- TRANSCRIPT --
Hello. I'm Dr Maurie Markman, from City of Hope. I want to briefly discuss a very interesting and complex topic. I certainly do not want to suggest that what I'm going to talk about over the next several moments is the definitive answer to the question that I'm going to pose, nor even an up-to-date analysis. The topic is the role, impact, or thinking processes of oncologists who are caring for patients with cancer when they decide whether to obtain genomic testing on their patients.
This is a new world today. Obviously, 20 years ago, we wouldn't be having this discussion at all. Today, in my opinion, these advanced testing strategies, and certainly genetic testing, are standard of care. It shouldn't even be a thought process that we would do it or not. Yet, it's problematic because of the evolving nature of the testing, the variety of insurance coverages, hundreds of different insurance companies, and government policies. The question does need to be asked.
[I want to talk about a paper,] "Importance of Patient Health Insurance Coverage and Out-of-Pocket Costs for Genomic Testing in Oncologists' Treatment Decisions." Unfortunately, this paper, which recently appeared in JCO Oncology Practice, was from a survey that was conducted in 2017. It's a bit out of date, but the point is that we don't have much information.
These physicians were asked the question, "How much does knowledge of the patient's insurance influence your decision to obtain the testing?" Almost half of the doctors, 47%, said this is a very significant factor, meaning if the insurance doesn't cover it, perhaps they won't order the test even though it might be lifesaving. Whether at the somatic level or at the germline level, it's a complex decision, but half said this is really an important decision, meaning there is concern that the insurance companies may not pay for it.
In addition, a question was asked about out-of-pocket costs. The insurance company might pay, but they may only pay 50% and the test may cost $1000 or more. Almost 60% of the doctors said they are very seriously concerned, or they care about, or they want to know about that, or that's going to influence their obtaining such testing.
Again, 50% said insurance coverage is very important and over 60% said they're very concerned about out-of-pocket costs even if insurance may pay. These are the opinions of oncologists. We need more information on this.
Obviously, we know about the financial burdens, the financial stress, and the financial toxicity for patients. Here, we're talking about testing that may be absolutely lifesaving; we may not even begin to predict what the outcomes would be. If you don't obtain the tests, you'll never have that information to help the patient.
This is becoming more and more important, with tumor-agnostic drug approvals by the FDA involving 1%-3% of patients. There is no way you would know that unless you obtain the test, and yet, doctors are very appropriately concerned about patients' ability to pay for the testing.
This is an important topic that we need much more conversation about in our society to figure out how we can overcome the issues related to our healthcare payment system. I thank you for your attention.
Transcript in its entirety can be found by clicking here:
https://www.medscape.com/viewarticle/...