Use of targeted therapy, healthcare costs, and survival with large panel testing, narrow testing, or no molecular testing in patients with metastatic non-small cell lung cancer (mNSCLC).

Abstract

8642 Background: Treatment guidelines recommend broad molecular profiling for patients with mNSCLC. With the availability of molecular tests with different genes, panel sizes, and specimen types, the testing landscape has become complex. This study aimed to evaluate use of biomarker-targeted therapy, healthcare costs, and overall survival with large panel, narrow, or no molecular testing for mNSCLC. Methods: This retrospective analysis used de-identified administrative claims from the Optum Labs Data Warehouse from 01/01/2016 to 03/31/2023. Commercial and Medicare Advantage enrollees with claims evidence of newly diagnosed mNSCLC between 08/01/2020 and 12/31/2022 were identified (index date = first diagnosis code for metastatic disease). Using procedure codes and laboratories on claims around the index date, patients were grouped by use of molecular testing as: 1) large panel (≥51 genes) testing; 2) narrow (individual gene or ≤50 gene panel) testing, or 3) no observed molecular testing. Outcomes evaluated in the variable follow-up period were targeted therapy use, healthcare costs (2022 adjusted) per patient per month (PPPM) in the first 180 days of follow-up, and overall survival. Results: Of 8,783 patients, 3,634 (41%) had large panel testing, 2,660 (30%) had narrow testing, and 2,057 (23%) had no observed testing; the remaining 5% of patients had molecular testing of unknown size. Use of targeted therapy was higher with large panel testing than narrow testing (12% vs. 8%, p<0.001) or no observed testing (3%, p<0.001). For commercial patients, mean ± SD total healthcare costs PPPM were higher for patients with large panel vs. narrow testing ($43,629 ± 33,097 vs. $38,642 ± 33,948, p=0.02) and were driven by higher pharmacy costs, but total healthcare costs PPPM were similar for patients with large panel vs. patients with no observed testing ($37,545 ± 50,329, p=0.11). For Medicare Advantage patients, mean total healthcare costs PPPM were similar (p>0.10) for patients with large panel ($18,321 ± 18,073), narrow ($18,462 ± 25,555), or no observed testing ($17,130 ± 31,955). Patients with large panel testing had higher median overall survival than patients with narrow testing (10.6 vs. 8.5 months, p<0.001) or no observed testing (10.6 vs. 5.9 months, p<0.001). Conclusions: Patients with large panel testing received targeted treatment at higher rates and had better overall survival than patients with narrow testing or patients with no observed testing. Total healthcare costs were similar with large panel testing vs. no testing and similar or higher (but driven by higher pharmacy costs) with large panel vs. narrow testing. Research is ongoing to assess outcomes among patient subgroups with treatment after adjusting for baseline differences between cohorts.