title: Use and Costs for Tumor Gene Expression Profiling Panels in the Management of Breast Cancer From 2006 to 2012: Implications for Genomic Test Adoption Among Private Payers.
abstract: OBJECTIVE
  Tumor gene expression profiling (GEP) can be used to predict recurrence risk and the potential benefit of breast cancer treatment. Adoption of GEP among privately insured patients has not been well studied. Our objectives were to characterize trends in GEP use and to evaluate per-use patient and health plan payments from 2006 to 2012.
  
  
  METHODS
  We used Truven Health Analytics MarketScan administrative claims database to examine GEP testing among women with breast cancer from 2006 to 2012 (N = 154,883). We estimated trends in the proportion of women who received GEP using segmented regression. We summarized average reimbursement for GEP, including insurer payments and patient out-of-pocket payments.
  
  
  RESULTS
  Overall, 18,575 women received GEP. The average age was 53.6 years, and most were enrolled in a preferred provider organization health plan. The adjusted proportion of women with breast cancer who received GEP grew from 2.2% in 2006 to 18.8% in 2012 (adjusted risk ratio, 8.4; 95% CI, 7.6 to 9.3). Out-of-pocket costs to the patient ranged from $0 to $4,752. Most patients paid nothing for GEP (median, $0; interquartile ratio, $4). Mean patient out-of-pocket costs were $175 (standard deviation [SD], $484). Private-insurer reimbursed amounts for GEP increased annually from an average of $3,125 (SD, $1,523) in 2006 to $3,680 (SD, $835) by 2012.
  
  
  CONCLUSIONS
  GEP has rapidly diffused into clinical practice. Reimbursements by insurers have increased slowly, and average out-of-pocket costs to patients have decreased, seemingly driven by improved coverage for testing over time. As more genetic tests become available, it will be important to understand how these technologies will affect cancer care costs across the US health care system.
authors.affiliation: Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; UNC Eshelman School of Pharmacy; and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Megan C
authors.initials: MC
authors.lastname: Roberts
authors.affiliation: Gillings School of Global Public Health; UNC Lineberger Comprehensive Cancer Center; UNC Eshelman School of Pharmacy; and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC Dusetzina@unc.edu.
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
mesh_terms: D000067575:Administrative Claims, Healthcare / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000235:genetics*; D005249:Fees and Charges / Q000706:statistics & numerical data; D005260:Female; D020869:Gene Expression Profiling / Q000191:economics* / Q000706:statistics & numerical data; D005820:Genetic Testing / Q000191:economics* / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000639:trends*; D007349:Insurance, Health, Reimbursement / Q000639:trends*; D008875:Middle Aged; D011243:Preferred Provider Organizations / Q000706:statistics & numerical data; D014481:United States