What Do Liquid Biopsies Add to Value-Based Cancer Care?

At a recent Institute for Value-Based Medicine® event in Houston focusing on increasing value in cancer care, Bhuvana Sagar, MD, practicing oncologist, Oncology Consultants, shared her insights on the evolving role of precision medicine in oncology. In this interview, Sagar highlights the transformative potential of liquid biopsies and the challenges faced by providers and payers in getting these tests done.

Transcript

How do you see liquid biopsy technology reshaping precision medicine testing in community oncology practices?

I think liquid biopsies are great. I think previously, we only had the tissue testing. So, with tissue testing, a lot of times we didn't have enough tissue to get things done, so liquid biopsy has made a huge difference. A lot of times when you don't have enough tissue or you can't run the test, that's a huge opportunity.

Can you talk through some of the challenges both payers and providers may face in getting this test done?

Absolutely. I used to be part of the payer side, I was on the payer side, and I've also been on the provider side. So, I can tell you from the payer standpoint, payers really do want to make sure patients are getting the testing done so that they can get the right therapies. From a provider perspective, the flip side of it is it is very challenging to get these tests done a lot of times very easily. It is not as easy as it seems, apparently. We get the biopsy done, and then you send the order out, [but] a lot of times there's not enough tissue. So, we just need to make sure those gaps are closed and providers made aware that there's not enough tissue. It's always easier to order the liquid biopsy at the same time to make sure if they don't have enough tissue, they can get at least a liquid biopsy test done.

I think we need to improve this a lot. I think the best way I can explain this is like breast cancer, for example. ER+, PR+, [and] HER2 automatically get reflex [testing] and automatically gets done. Can we get there with lung cancer? I think hopefully with time, the technology will become cheaper, these tests will become less expensive overall, and maybe we can do these reflexively instead of worrying about the cost of these tests, are we going to utilize the test, and so on and so forth. Because patients really need these tests to make sure they're getting on the right therapy.

How does this approach to testing align with the principles of value-based care?

In general, if you think about value-based care, [it] is a complicated topic. Because when you're thinking about value-based care, whose value are we quantifying? At the end of the day, when you think about it from a patient standpoint—which is the most important thing—we need to make sure patients are getting the right therapy. From that standpoint and making sure that is addressed is really key.

A great example is breast cancer or lung cancer, for example. In breast cancer, we have Oncotype [DX], we have MammaPrint, we have all these tests, and what they have done is decrease the utilization of chemotherapy in scenarios where patients are not going to benefit from that. So that, I think, is adding value. Same thing with lung cancer or other cancers. This happens in every other cancer type, but the reason I brought up breast and lung as those are the most common cancer types. And in all these cancers, as long as patients are getting the test, getting on the right therapy, and getting better—not ending up in the hospital—that adds to the value. So, I think that will decrease total cost of care.

Now, some of these drugs that are coming out are really high cost. So overall, I'm not sure if we're going to lower the total cost of care, because these drugs are really expensive. But they are adding survival and improvement of symptoms for patients, so it's a valuable tool in our toolbox.