The value of multicancer early detection tests is based not only on cost, but cost in relation to the outcomes, said Patricia Deverka, MD, MS, senior researcher, deputy director at the Center for Translational and Policy Research and Precision Medicine, University of California San Francisco.
Patricia Deverka, MD, MS, senior researcher, deputy director at the Center for Translational and Policy Research and Precision Medicine, University of California San Francisco, explains how payers, providers, and patients all play a role in the success and value of multicancer early detection (MCED) tests.
What challenges do you anticipate when determining the value of MCED tests, taking into account the perspectives of payers, providers, and patients?
Clearly for payers, I think that there will be interest in the short-term affordability or budget impact of making these tests available to their covered population. I think that is something and, typically, budget impact looks at the initial 1, maybe 2 years out after a new technology is introduced. So I think affordability and budget impact will be very important for payers, but I also think, particularly Medicare, they will be interested in long-term cost-effectiveness, which I would say is sort of my definition of value—not simply looking at cost in isolation but cost relative to the outcome. So I do think that they will [be interested], and that's going to be driven by the cancer-specific survival benefits of earlier detection of cancers, taking into account that there will be false positives and essentially cost associated with the diagnostic workup of people that ultimately don't have a cancer.
Right now, when looking at these tests, payers right now don't have a clear multicancer framework to show how they will be evaluating the value of these tests. I think that providers are really going to need to know the cancer detection rates by cancer type and by stage, and that will vary. I think they'll be very interested in the diagnostic pathway that's pursued for people who screen positive and how those referrals and handoffs get to a final confirmed or unconfirmed diagnosis of cancer—so the true positives, the false positives. And I think providers would be very interested to see how to integrate these tests with current standard-of-care screening, and what patients continue to get their mammograms and colonoscopies, or lung CT if they're a heavy smoker. All of that will be very important.
I think the patients really need to weigh in on, what are the behavioral and quality-of-life effects of these cancer tests? Does this cause any emotional distress? How does it affect their adherence to standard-of-care screening? Are they willing or able to do cost sharing for all of the out-of-pocket expenses that may accrue with follow-up diagnostic procedures?
Those are all some of the information gaps that we currently have and what information will need to be developed to support the appropriate clinical integration of these tests.
Transcript edited for clarity.