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Commercial price variation in precision oncology testing across US hospitals
Maryam Mooghali1,2, Joshua J Skydel2,3, Cary P Gross1,4
1Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, United States.
Introduction:
Precision oncology biomarker testing informs prognosis and guides treatment selection. These tests represent a growing component of cancer care costs.
Methods:
We conducted a cross-sectional study of US commercial payer-negotiated rates for biomarker tests for breast, colon, and non-small cell lung cancer, using Turquoise Health hospital pricing database. Outcomes included geographically adjusted payer-negotiated rates, within- and between-hospital price variation, and differences by payer, rurality, and hospital size, assessed using generalized linear models adjusted for multiple comparisons.
Results:
We identified 422 515 negotiated rates for 28 biomarker tests across 2142 hospitals. Median proportion of hospitals reporting payer-negotiated rates was 18.3% (interquartile range [IQR]:17.2%-18.8%) for panel-based and 30.3% (IQR:22.2%-37.8%) for non-panel-based tests; median negotiated rates per test were $3704 (IQR: $3096-$4129) and $301 (IQR: $157-$485), respectively. Negotiated rates varied within hospitals (median within-hospital ratios: panel-based tests, 1.5 [IQR:1.4-1.5]; non-panel-based tests, 1.6 [IQR: 1.5-1.7]) and between hospitals (median between-hospital ratios: panel-based tests, 5.5 [IQR: 5.5-5.6]; non-panel-based tests, 5.2 [IQR: 5.1-5.4]). Negotiated rates varied significantly by payer for all tests.
Conclusion:
Our findings revealed wide variation in commercial payer-negotiated rates for oncology biomarker tests, underscoring the need for pricing transparency and efforts to reduce price variation to support equitable, affordable cancer care.