Patients Willing to Pay Out of Pocket for Genetic Testing to Assess Colorectal Cancer Risk

Audrey Andrews

July 2012, Vol 3, No 5 - ASCO Annual Meeting

Chicago, IL—In a cohort of patients at risk for colorectal cancer (CRC), the majority were willing to pay some out-of-pocket (OOP) expenses for genetic testing, Fox Chase Cancer Center researchers reported in a poster that was presented at the 2012 American Society of Clinical Oncology (ASCO) meeting and earned an ASCO Merit Award.

“These participants are fearful of a positive result and anticipate benefits afforded by genetic testing in controlling cancer risk,” said Jennifer M. Matro, MD, a medical oncology fellow at Fox Chase in Philadelphia.

The increasing availability of genetic testing in cancer care has been paralleled by increasing cost-sharing practices by payers. Little is known about the factors that may influence a high-risk patient’s willingness to pay for these genetic tests. The study was conducted to obtain such information from a cohort of patients referred for genetic risk assessment.

At enrollment in the Gastro intes – tinal Tumor Risk Assessment Registry, 406 participants (73% female) completed a survey that collected detailed demographic data, cancer history, and psychosocial items related to cancer risk. The patients were presented with the following scenarios:

  • I plan to have genetic testing for CRC only if my health insurance covers it
  • I plan to have a genetic test for CRC, even if I have to pay for it myself
  • For a genetic test for CRC, I would be willing to pay: $25, $50, $100, $200, $500, $1000, $2000.

The results showed that 80% of patients were willing to pay OOP, whereas 20% would want the test only if insurance covered the full cost, reported Dr Matro.

The percentages of patients willing to pay OOP (if the test was not covered by insurance) were:

  • 26% would pay up to $200
  • 22% would pay $1000-$2000
  • 20%would pay $500
  • 20% would pay $100
  • 12% would pay $25-$50.

Who Was Most Willing to Pay for Genetic Testing?

The independent predictors of willingness to pay included the expectation of a positive result, confidence in being able to better control cancer risk, fewer perceived barriers to CRC screening, and belief that benefit is derived from having screening guidance. Patients willing to pay a higher amount were more likely to be male, be more educated, have greater cancer worries and fewer first-degree relatives with CRC, and have more positive attitudes toward genetic testing.

Dr Matro speculated on why participants with more first-degree relatives and a history of colon cancer were less likely to pay more. “The reasons for this may include that these patients assume the test will be positive, or feel more comfortable navigating the healthcare system and getting appropriate care without the test result,” she suggested.

Despite the analysis being controlled for household income, women and less-educated patients were willing to pay a smaller sum, indicating that they may face greater individual barriers from high copays, she reported.

“Identifying patient-level factors associated with willingness to pay for genetic services is increasingly important as genetic testing is integrated into routine cancer care,” Dr Matro said.