title: Cost estimates and economic implications of expanded RAS testing in metastatic colorectal cancer.
abstract: BACKGROUND
  In colorectal cancer (CRC), evidence shows that expanding RAS testing to analyze more mutations may better predict benefit from anti-EGFR therapy. The economic implications of expanding RAS testing for metastatic CRC were analyzed.
  
  
  METHODS
  Estimates of standard KRAS exon 2 testing were based on the Centers for Medicare and Medicaid Services (CMS) 2014 Diagnostic Laboratory Fee Schedule, and expanded RAS testing was estimated using a sensitivity analysis done with various potential cost scenarios (1, 2, 10, and 30 times the cost of the standard KRAS test). The cost estimates for cetuximab and panitumumab were based on the CMS payment allowance limits for Medicare Part B.
  
  
  RESULTS
  A total of 28,692 patients with metastatic CRC were estimated to be eligible annually for RAS testing. For cetuximab, the societal cost of standard KRAS testing plus the drug versus expanded testing plus the drug would be $1.16 billion versus $816 million if the cost of the tests were the same. If the cost of the expanded RAS test were 30 times the cost of the standard test, then the societal cost of standard KRAS testing plus the drug versus expanded testing plus the drug would be $1.16 billion versus $980 million, a continued savings of more than $184 million annually. Similar savings were seen with panitumumab.
  
  
  CONCLUSIONS
  The increased societal cost of expanded RAS testing versus standard approved KRAS exon 2 testing was inconsequential when compared with the amount of money saved by not treating the additional 18% of patients who harbor additional RAS mutations (beyond exon 2) with anti-EGFR therapy.
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA skircher@nmff.org.
authors.forename: Sheetal M
authors.initials: SM
authors.lastname: Kircher
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Mohindra
authors.affiliation: Department of Medicine, Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Halla
authors.initials: H
authors.lastname: Nimeiri
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000235:genetics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D009362:Neoplasm Metastasis; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins / Q000235:genetics
chemical_list: D000970:Antineoplastic Agents; C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins
keywords: Antineoplastic agents; Colorectal neoplasms/drug therapy; Drug costs; Human; KRAS protein