How Does Biomarker Testing Affect Out-of-Pocket Costs for Patients With NSCLC?

Laila Gharzai, MD, of the Northwestern University Feinberg School of Medicine, discusses her poster presentation on the impact of lung biomarker testing on out-of-pocket costs for metastatic non-small cell lung cancer (NSCLC) during the 2024 American Society of Clinical Oncology Annual Meeting.

Dr. Gharzai, a radiation oncologist, explained why it was important to conduct the research and understand the financial impacts of lung biomarker testing.

“One of my big research interests is in financial toxicity, which is this idea that we know patients get diagnosed with cancer, we know that we treat them, but [there are] all these downstream financial consequences that happen to patients: either they can’t work, they end up decreasing their income, or they can lose their jobs,” she said. “All sorts of things can happen to patients that impact their finances.”

This makes it important to take a “broader, system-level look at the financial consequences of being diagnosed with cancer,” Dr. Gharzai explained. The poster presentation focused on assessing lung biomarker testing and the downstream costs associated with it, she said, noting that she and her colleagues used a claims-based dataset to gather information on testing and costs.

The study showed that the “vast majority” of patients with lung cancer are receiving biomarker testing, and “there were no real discrepancies on who is getting the test,” Dr. Gharzai said, noting that “the patients [who] need it are typically getting it.” However, the study identified that patients who were older or who were smokers were less likely to get the biomarker testing, as patients who smoke “typically don’t have a lot of targetable mutations.”

In terms of cost, Dr. Gharzai and colleagues showed the biomarker test had a median out-of-pocket cost of $98, which “is substantial but much lower than it used to be,” she explained. However, it’s important to recognize that biomarker testing is being conducted “more commonly,” which makes it critical to look at costs over time.

“For patients [who] did not get biomarker testing and for [those who] did get biomarker testing, if you look at the cost in the first 6 months after they were diagnosed, it’s about $1900 for patients [who] don’t get tested, but it goes all the way up to $3500 for patients [who] do get tested,” Dr. Gharzai said. “That’s almost double. Our patients [who] are getting tested are subsequently sharing a larger burden in out-of-pocket costs that they are then paying for after their initial diagnosis and subsequent treatment.”

There were limitations of the dataset used in the study that are important to recognize, she said, noting that patients on Medicare were not included, and the data did not allow the researchers to see what patients paid, only what they were billed.

“Sometimes those [bills] are negotiable,” Dr. Gharzai explained. “Someone who’s struggling to pay can often work either with the hospital or with other people to reduce that rate, or sometimes things end up changing for other reasons due to discounts. This doesn’t actually reflect the money out of the pocket, but it reflects that bill that comes in the mail.”

Despite these limitations, the study provided important insights on the biomarker testing landscape in patients with lung cancer and the associated financial impacts on patients.

“Overall, we were able to show that most patients are getting tested. We were able to show that it happened early on in treatment but is associated with this significantly higher cost over the first 6 months,” Dr. Gharzai said.

She concluded by reflecting on the clinical implications of the research and what she hopes that health care professionals will take away from the study.

“We really need to understand…the downstream financial consequences of everything,” Dr. Gharzai said. “So, as a physician, I routinely am ordering tests…putting in orders for imaging, for blood tests, for all sorts of things. But we need to really understand, for each test that we order, it can have these consequences months down the line for patients. What does that end up doing in terms of out-of-pocket costs, ability to work, [and] all of these other challenges that patients can experience? There’s much, much, much more work that needs to be done in this space.”