Commercial Price Variation in Precision Oncology Testing Across U.S. Hospitals
Maryam Mooghali, Joshua J Skydel, Cary P Gross, Stacie B Dusetzina, Zenta Walther, Maryam Lustberg, Joseph S Ross, Joshua D WallachAbstract
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 U.S. 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 2,142 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 $3,704 (IQR: $3,096-$4,129) 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.