Grant Details
Grant Number: |
3R01CA277599-02S1 Interpret this number |
Primary Investigator: |
Kinney, Anita |
Organization: |
Rutgers Biomedical And Health Sciences |
Project Title: |
Multilevel Factors Associated with Disparities in the Use of Targeted Cancer Therapies in Medicare |
Fiscal Year: |
2023 |
Abstract
ABSTRACT
This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-
23-044. Identification of patients with pathogenic variants is crucial to enable the use of treatment and guide
prevention. Yet, there are important racial disparities in genomic cancer medicine: for example, Black persons
experience significant disparities in access to germline cancer genomic services and bear the largest cancer
mortality burden of any racial/ethnic group. Preliminary evidence suggests that there may also be disparities in
the use of genomically-targeted therapies. While the parent R01 focuses on well-known disparities in germline
cancer genomic risk testing, considerably less is known about whether there are disparities in the use of
genomically-targeted cancer therapies. We will assess these disparities and the potentially important role of
health policy factors as they relate to disparities among cancer cases ages in Medicare. In March 2018, to
improve Medicare beneficiaries’ access to targeted genomic cancer therapies, CMS issued a national
coverage determination (NCD) paying for Next Generation Sequencing (NGS) based tumor genomic tests for
patients with advanced or metastatic cancer and no previous NGS testing. Implementing the new payment
policy by Medicare is intended to increase the use of genomically-targeted cancer treatments. However, little is
known about how the implementation of the national policy for NGS testing has influenced disparities in the
use of genomically-targeted therapies. To inform future healthcare coverage policies around genomic cancer
medicine, it is important to assess whether the coverage policy equitably addresses access to effective
treatment, given the disparities observed in both genetic testing and targeted treatments. This study will
address this gap. Using the most recent five years of SEER-Medicare Part D data, we will first document
whether the implementation of NCD for NGS testing has increased the use of genomically-targeted therapies.
Then, we will examine whether there are racial and socio-economic disparities in the use of these therapies,
accounting for the 2018 NCD for NGS testing. The use of selected genomically-targeted oral anticancer drugs
before vs. after the NCD will be the primary outcome of interest. Policy-level variables will include health
insurance factors such as patients’ Medicare Advantage enrollment, low-income subsidy status, and patients
with coordination of benefits from third parties. The specific aims of the proposed study are to 1) compare the
use of orally administered genomically-targeted cancer agents among Medicare beneficiaries before and after
the implementation of the 2018 NCD policy for NGS testing; 2) examine racial-ethnic and socioeconomic
disparities in the use of oral genomically-targeted cancer drugs associated with insurance benefit designs.
Findings from this study can be used to inform policy decisions for advancing cancer health equity and
improving access to genomically-targeted cancer therapies. This approach could be applied to other drugs and
genomic medications, as well as value-based healthcare initiatives.
Publications
None. See parent grant details.