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Out-of-Pocket Costs Could Deter Patients from Genetic Risk Tests

NEW YORK (GenomeWeb News) – If genetic tests that predict individual cancer risk are not reimbursed by health insurers, some people who have received referrals for those tests may opt not to take them, according to a new study from Fox Chase Cancer Center.

According to the Fox Chase study of patients who were referred by doctors to have genetic tests for colorectal cancer mutations, around one-fifth of the patients said they would only take the test if their insurance covers the cost.

Around 21 percent of the 406 patients in the study, who were identified by doctors for CRC risk based on their personal and family histories, said they would choose not to take a test if it is not covered by insurance.

Although 79 percent of patients in the study said they were willing to pay some out of pocket expenses to have the test, nearly 90 percent of that group put a limit on how much they would pay, with most saying that they would not pay more than $500 out of pocket.

According to the study's author, Fox Chase Medical Oncology Fellow Jennifer Matro, genetic testing has become more popular at the same time that healthcare payors have been increasing cost-sharing practices, which are intended to reduce the overuse of services by increasing employee and employer contributions. Within the context of these two trends, out-of-pocket costs could be a deterrent for some who have been referred to take hereditary cancer risk assessment tests, Matro suggested.

Matro presented the findings at the 2012 American Society of Clinical Oncology conference in Chicago last weekend.

These tests could benefit patients and payers, she said, explaining that even though some genetic tests can cost thousands of dollars, discovering mutations for cancer risk early on will spur patients to schedule regular screenings and check-ups.

"Cancer care is becoming more personalized, but there are costs to that," Matro said in a statement. "The goal of genetic testing is to give patients the best opportunity to detect their cancers earlier, which can save costs in the long run."

According to Matro's report, genetic tests are becoming more common across the clinical spectrum and can be used to reduce medical costs in the later phases of cancer care as well. When someone develops colorectal cancer, for example, a test is that is covered by all insurers is performed on the tumor to identify patients at risk for Lynch syndrome, which would put them at risk for other cancers. If that test is positive, another test is ordered to diagnose the syndrome, but if that screen is negative no additional testing is done.

The study also found that people who were more worried about their risk of cancer and who had more positive attitudes about genetic testing were willing to pay higher costs for the CRC tests.

On the other hand, women, people who were less educated, and those with more first-degree relatives who had cancer were less likely to agree to high co-pays for the test.

Matro suggested that the finding about education and gender may be due to cost, as people with less education also tend to make less money, and women may not be the primary breadwinners in the household and have less access to money.

"It's counter-intuitive that people with more relatives who had cancer would be willing to pay less for genetic testing," she said. "Perhaps they assume the test will be positive, so don't want to be saddled with a hefty co-pay. Alternatively, they may feel confident navigating the healthcare system after helping family members with cancer, and believe they can handle whatever diagnosis they eventually receive."

Matro recommended that researchers try to learn more about which patients are most at risk and most in need of tests, so that those who do not have enough risk factors can avoid the tests entirely.

"We need to discover more risk factors for genetic mutations, so we can spare those patients who really don't need to pay for genetic testing," she said.

The study was supported in part by the 2012 Conquer Cancer Foundation of ASCO Merit Award, Mentored Research Scholar Grant from the American Cancer Society, and the National Cancer Institute.

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