The Cost of Next-Generation Sequencing
- Next-generation sequencing (NGS) is a cutting edge technology and a type of molecular testing analyzing large portions of DNA which is used to identify specific mutations in cancer cells, detect hereditary cancer mutations which are inherited from parents, and identify appropriate targeted therapies.
- Although valuable in certain clinical situations, NGS remains expensive with most tests costing thousands of dollars.
- Fortunately, as NGS technology continues to improve and indications for NGS expand, the total cost of NGS is decreasing and the coverage by insurance companies is improving.
- It is important to discuss the usefulness of NGS testing with your healthcare team prior to undergoing testing.
NGS has several advantages in that it can analyze hundreds to thousands of potential mutations in DNA in a single test over a relatively short period of time. The ability of NGS to sequence a large amount of DNA simultaneously in one test has the potential to save money, time, and tissue especially if many markers or mutations in DNA need to be tested.Read More
Trends In NGS Cost and CoverageIn certain scenarios where multiple genes need to be tested, NGS can be the test of choice. However, NGS is still relatively expensive and “can be in the order of several thousand dollars,” according to Dr. Valsamo Anagnostou, a thoracic oncologist and the leader of the Johns Hopkins Molecular Tumor Board at The Sidney Kimmel Comprehensive Cancer Center. Despite the price tag, NGS is a relatively new technology and the price has continued to decrease for several reasons over the past decade including continued technological advancements, market competition, and economic scalability. “There is a lot of effort to decrease the cost of next-generation sequencing down to below a thousand dollars”, says Dr. Anagnostou.
Your personal financial responsibility and the medical insurance coverage can vary significantly based on your insurance provider, cancer type, and disease status. In 2018, Medicare issued a national coverage determination and provided reimbursement for NGS tests for Medicare beneficiaries with advanced or metastatic cancer with no prior NGS testing. Before this, NGS coverage was often restricted to specific tumor type or DNA mutations. This has increased the utilization of NGS in several cancer types including lung, breast, and colorectal cancer.
Although the cost continues to decrease, the use of NGS in clinical decision-making becomes more widespread, and coverage by Medicare and Private Insurance companies continues to increase. It is important to discuss insurance coverage with your healthcare team.
When Is NGS Testing Appropriate?
Coverage and reimbursement are variable depending on the cancer type, overall disease status, and the insurance company. When undergoing any testing that can bring additional financial cost, it is important to discuss whether the test will have clinical utility. Meaning, will this test have the opportunity to change treatment and potentially offer new therapies that will effectively treat my cancer? It is important to discuss the need and rationale for NGS with your healthcare team. If NGS will not change treatment decisions made regarding your cancer and does not offer any clear potential benefit, it can add unnecessary cost and use valuable tissue from your prior biopsies.
If your doctor determines an NGS test could potentially help you but costs remain high, here are some ways you may be able to navigate roadblocks:
- You can appeal the health plan decision. This can be an internal appeal or an external review.
- Your doctor can negotiate on behalf of the insurance company.
- Many hospitals have a social worker or a case manager who is tasked with helping you with aspects of your care and insurance. They can help advocate for you.
NGS should be considered if your cancer has several identifiable mutations or molecular targets that are commonly seen and targetable with therapies or offer important information for clinical decisions. For other cancers that do not have as many known mutations or target therapies, there is a possibility that NGS can identify a mutation with a new treatment option, however, this is not common.