TRANSPERS Publishes on Multi-Cancer Early Detection Tests, Prenatal Exome Sequencing, and Health Inequalities
Letter from the Director
As we celebrate the beginning of Fall, we are delighted that TRANSPERS collaborators continue to delve into timely policy issues. This newsletter highlights publications on multi-cancer early detection tests, prenatal exome sequencing, and the health inequality impact of liquid biopsy testing for advanced non-small-cell lung cancer.
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Multi-Cancer Early Detection Testing May Impact Primary Care Providers
In the September issue of Healthcare, TRANSPERS collaborators Grace Lin and Kathryn Phillips, along with A. Mark Fendrick, Professor and V-BID Director, University of Michigan, examine key issues for primary care providers regarding multi-cancer early detection tests (MCED.) MCED tests are already on the market and patients are requesting testing, but primary care providers may not be ready to provide the needed counseling and testing.
This article continues work by TRANSPERS collaborators on the policy implications of MCED tests. In a paper led by Patricia Deverka, the authors described the potential benefits of an MCED test that could detect multiple cancers and illustrated how this innovation would complicate payer decision-making. In another study, Julia Trosman et al reported that payers’ perspectives, concerns, and evidentiary needs should inform evidence development for MCED screening programs.
Access To Prenatal Exome Sequencing For Fetal Malformations: A Qualitative Landscape Analysis In The US
TRANSPERS-funded collaborators Nuriye Sahin-Hodoglugil, Mary E. Norton, and others published a study in Prenatal Diagnosis examining clinician perspectives on the utility of prenatal exome sequencing (ES). There is increasing evidence supporting the clinical utility of ES for identifying fetal genetic disorders. This study found that prenatal ES is seen as an opportunity for a continuum of care before, during, and after a pregnancy, not solely as informing decisions about abortions. However, cost and coverage of the test were access barriers.
This continues work on the important topic of equitable access to genomic technologies for prenatal diagnostic testing as described in Dr Norton’s work in the New England Journal of Medicine.
Jeroen Jansen Leads Study Examining Health Inequality Impact Of Liquid Biopsy For Advanced Non-Small Cell Lung Cancer
In a study in Value in Health, Jeroen Jansen and other TRANSPERS collaborators used distributional cost-effectiveness analysis to quantify the health inequality impact of liquid biopsy (LB) (followed by tumor biopsy testing) relative to a tumor biopsy testing only strategy to inform first-line treatment of advanced non-small-cell lung cancer (aNSCLC). They found that LB testing can result in improved health outcomes for patients, but that the benefit is likely the greatest among Asian patients thereby potentially widening existing differences in survival between patients with aNSCLC of different race and ethnicity.
Although coverage by private payers was common for ctDNA for initial treatment selection, there was more variability in coverage for testing for progression and MRD. Non-small cell lung cancer was the cancer type most frequently covered for initial treatment and progression. Of the 14 Medicare policies, most provided coverage for initial treatment selection and progression, but fewer provided coverage for MRD. Most policies restricted coverage to patients without available tissue, or if biopsy was contraindicated.
Upcoming Conferences and TRANSPERS Presentations
Kathryn Phillips will be attending the Genetic Health Information Network Summit in Nashville, Tennessee Oct 25-27, 2023. Kathryn will be presenting TRANSPERS research led by Julia Trosman on understanding payer perspectives on implementation of precision medicine.
The 17th Annual Personalized Medicine Conference on Nov 30 – Dec 1, 2023 will convene the world's leading scientists, business executives, and policymakers to explore the opportunities and challenges shaping the future of personalized medicine. Joining industry and government leaders, Kathryn Phillips will participate in a panel on Multi-Cancer Early Detection Technologies: When and How Should They Be Integrated into Health Care. Register now!
TRANSPERS continues its engagement with the National Academies Roundtable on Genomics and Precision Health. Kathryn Phillips will be presenting TRANSPERS research being conducted with Grace Lin on the emergence of state legislation requiring insurer coverage of biomarker testing at their next meeting. A registration link to the public program will be coming soon!