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. 2018 Apr;20(4):428-434.
doi: 10.1038/gim.2017.118. Epub 2017 Sep 21.

Trends in utilization and costs of BRCA testing among women aged 18-64 years in the United States, 2003-2014

Zhuo Chen  1   2   3 , Katherine Kolor  1 , Scott D Grosse  4 , Juan L Rodriguez  5 , Julie A Lynch  6   7 , Ridgely Fisk Green  1   8 , W David Dotson  1 , M Scott Bowen  1 , Muin J Khoury  1
Affiliations

Trends in utilization and costs of BRCA testing among women aged 18-64 years in the United States, 2003-2014

Zhuo Chen et al. Genet Med. 2018 Apr.

Abstract

PurposeWe examined 12-year trends in BRCA testing rates and costs in the context of clinical guidelines, national policies, and other factors.MethodsWe estimated trends in BRCA testing rates and costs from 2003 to 2014 for women aged 18-64 years using private claims data and publicly reported revenues from the primary BRCA testing provider.ResultsThe percentage of women with zero out-of-pocket payments for BRCA testing increased during 2013-2014, after 7 years of general decline, coinciding with a clarification of Affordable Care Act coverage of BRCA genetic testing. Beginning in 2007, family history accounted for an increasing proportion of women with BRCA tests compared with personal history, coinciding with BRCA testing guidelines for primary care settings and direct-to-consumer advertising campaigns. During 2013-2014, BRCA testing rates based on claims grew at a faster rate than revenues, following 3 years of similar growth, consistent with increased marketplace competition. In 2013, BRCA testing rates based on claims increased 57%, compared with 11% average annual increases over the preceding 3 years, coinciding with celebrity publicity.ConclusionThe observed trends in BRCA testing rates and costs are consistent with possible effects of several factors, including the Affordable Care Act, clinical guidelines and celebrity publicity.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.. Rates of BRCA tests and subtypes per 100,000 women aged 18–64 years: MarketScan and revenue estimates.
A. Growth in BRCA testing rates among women aged 18–64 years per 100,000, MarketScan CCAE databases versus revenue estimates, 2003–2014. B. Utilization rates of any BRCA test and subtypes among women aged 18–64 years, 2003–2014 (per 100,000 MarketScan CCAE databases enrollees). Subtypes include full-gene sequencing, known variant, Ashkenazi panel, and large rearrangement tests.
Figure 2.
Figure 2.. Rates of BRCA testing by age group per 100,000 women aged 18–64 years, MarketScan CCAE databases, 2003–2014
A. BRCA test rates (per 100,000 enrollees) among women by age group: 18–34 years, 35–44 years, 45–54 years. 55–64 years. B. Percent of BRCA testing among women by age group, 2003–2014.
Figure 3.
Figure 3.. Percent of BRCA testing among women aged 18–64 years by personal or family history of breast or ovarian cancer, MarketScan CCAE databases, 2003–2014.
Women with any BRCA test stratified by diagnosis groups: newly diagnosed breast or ovarian cancer (incident), previously diagnosed breast or ovarian cancer (non-incident), family history of breast or ovarian cancer, and other.
Figure 4.
Figure 4.. Costs of BRCA test and subtypes, MarketScan CCAE databases, 2003–2014.
A. Total payment to provider amount per enrollee for BRCA test and subtypes, and percentage of enrollees with zero out-of-pocket payment for any BRCA test (right axis). Subtypes include full-gene sequencing, known variant, Ashkenazi panel and large rearrangement tests. B. Percentage of zero OOP payment among women by diagnosis group: family history of breast or ovarian cancer, newly diagnosed breast or ovarian cancer (incident), previously diagnosed breast or ovarian cancer (non-incident), other.
Figure 5.
Figure 5.. Regional BRCA Test Rates and Relative Rates per 100,000 women aged 18–64 years, MarketScan CCAE databases 2003–2014.
A. BRCA test rates by geographic region: Northeast, Midwest, South, West. B. Relative BRCA Test Rates by geographic region, compared to Northeast region. Northeast: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Pennsylvania. Midwest: Illinois, Indiana, Michigan, Ohio, Wisconsin, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota. South: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma, Texas. West: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming, Alaska, California, Hawaii, Oregon, Washington.
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