As we  pave the way for better patient outcomes with the first minimally invasive microbiome-driven liquid biopsy technology, we also want to make sure that the important economic benefits that health insurance companies will reap from covering early cancer screening using the Oncobiota™ platform–are clear.

The message is simple: the economic case for incorporating Micronoma’s test into the healthcare system is just as strong as the scientific one.

By supporting our mission to improve patient lives by catching cancer earlier, insurance companies stand to save hundreds of thousands of dollars compared to current best practices for diagnostic and treatment guidelines.

As noted in a previous post, Micronoma is focusing on diagnosing lung cancer first because it is among the most common and deadliest of cancers, and early detection is key to improving patients’ chance of survival. But to sum up, only about 15 percent of the 228,000 patients diagnosed with lung cancer annually will survive five years following a late-stage diagnosis.  About 25% of all US cancer deaths each year are due to lung cancer alone.

Starting with our original discovery, published in Nature, we have built a strong body of science showing the clinical utility and efficacy of using microbiome markers to detect cancer. The foundational soundness of that science, including in early stages of the disease (stages I and II)  provides a compelling starting point for making the case to insurance companies about the large long-run cost-effectiveness ratio benefits that will accrue from adding the  Oncobiota™ platform to the list of tests they will cover.

“Early screening is the key to not only better outcomes for patients, but a better economic picture for insurers,” Micronoma Vice President of Business Development Todd Czerwinski said.

“If we do lung cancer screening up front, we can dramatically drop the cost of how things look on the backend of this when you take in the totality of the patient’s experience; from presenting, all the way through to what the final therapy might look like,” he said, adding there are ancillary cost benefits, such as just freeing up operating rooms and physician time when fewer unnecessary tissue biopsies are conducted.

To begin with, only about 5 percent of the at-risk-of-lung-cancer population that the US Preventive Screening Task Force (USPSTF)  and the Centers for Disease Control and Prevention (CDC) recommends to be screened for lung cancer do so. The first step to screening is a non-invasive, cost effective method Low Dose CT Scan (LDCT). Yet, 95 percent of those who are 50-plus-years-old and have smoked more than a pack of cigarettes per day during their adult life (“20 pack-years” or more) don’t take this step until symptoms like coughing up blood, having pain in a lung, or trouble breathing appear. This usually leads to lung cancer being discovered in the latest stages: stage III or stage IV cancer.

By then it can be too late to provide effective treatment for many. Four out of five people who present with stage IV lung cancer die within three years. The total costs from diagnosis through treatment for those patients escalates quickly and can total in the hundreds of thousands of dollars, and with less than desirable results for too many.

While the initial LDCT scans relied upon now for initial screens are relatively inexpensive, they are not designed to effectively distinguish benign lung nodules from lung cancer (5% of the nodules discovered), resulting in the need for more expensive PET CT scan or risky lung biopsies. One in five patients who go in for a lung biopsy suffer complications like collapsed lungs or severe lung infection, resulting in the need for further treatment and hospitalization.  Costs tend to be higher for lung biopsies in patients with a complication (averaging about $14,000 each) vs. without a complication (averaging about $7600 each) depending on the state where they are conducted.1 In addition, about 30% of these biopsies come back as inconclusive due to not enough of a sample collected.

All of that comes with a cost to the patient and insurer. Those costs go up even faster and further if lung cancer is detected and needs to be treated, an average of $245,000 or more over a stage IV patient’s lifetime.

We expect that early screening using our test, enabling the use of effective and less costly treatment avenues (such as surgery) will put it on the other end of the cost spectrum, saving lives and tens of thousands of dollars per year of treatment.

All told, being able to offer a simple blood draw to determine malignancy of a nodule after a LDCT, instead of having only to resort to PET CT and/ or tissue biopsies, would likely motivate practitioners to more actively press their at-risk patients to get the LDCT screening done. As mentioned earlier, 5% compliance in screening is quite low for such a deadly cancer when you realize that compliance for colonoscopy is around 60% and mammograms are about 75%. Imagine, simply boosting the compliance of eligible people for a LD CT scan from the current 5 percent rate to 10 percent by offering a simple follow up test, would lead to doubling the number of people actively diagnosed in an early stage while enabling healthcare to save money and lives.

“People are dying of something that’s eminently curable if it’s caught early enough as stage I cancer patients have a 5-year survival rate as high as 80% ,” Czerwinski said. “There needs to be an effective way to capture this cancer earlier.”

 

1DOI: 10.1200/JOP.18.00762 Journal of Oncology Practice 15, no. 8 (August 01, 2019) e717-e727.
Cost adjusted to 2022 values.