Genomic Sequencing Procedure Cost and Value Models

Download These Models to Effectively Communicate the Cost and Value of GSP Services to Medicare and Commercial Payers.

In 2014, AMP initiated a micro-costing and health economic evaluation of several of the GSP CPT codes. AMP collected over a dozen protocols to analyze cost information about laboratory validation, pre-analytics, sequencing, bioinformatics and interpretation. AMP members can use aggregate data from this micro-costing project to estimate the cost of performing GSPs in their own laboratory. Also, AMP developed a blank micro-cost template to enable laboratories to micro-cost their version of these GSP services as well as other GSP services.

Secondly, AMP recognizes that demonstrating the value of genomic sequencing procedures to key payers and clinical stakeholders will be critical to establishing a favorable and transparent reimbursement and market access environment. Consequently, we developed 3 exemplar health economic value models based on published and unpublished data from a variety of key centers around the US.

1. Hearing loss panel that focuses on the value that a GSP brings by avoiding a diagnostic odyssey.
2. Whole exome analysis that provides a cost effective tool to diagnose causes of developmental delay with increases in diagnostic yield.
3. Tumor panel for NSCLC patients with advanced disease, which results in an increase in the use of targeted therapy, resulting in a marginal increase in costs but added clinical benefits such as avoidance of adverse events and increases in PFS.

These models represent a snapshot of current GSP procedures. AMP’s goal is to provide these models so that laboratories will use them to articulate the cost and value of the GSP services they provide to both Medicare and commercial payers. Over time, these models can be adapted and updated to reflect changes/innovations in GSPs.

A webinar and video tutorial are available for viewing. The webinar will explain the coding for new genomic sequencing procedures, provide an overview of the cost and value project, and instruct on how to put the tools into practice. The video tutorial will provide step-by-step instructions for completing the blank micro-cost template model so that laboratories can micro-cost their own GSP services.

April 13, 2016 Update: In the process of preparing, editing, and publishing the JMD manuscript on the results of this study, there were a number of changes made to the models since they were uploaded onto this page in March 2015. The new models were labeled with updated versioning and are now available for download below. Changes to models include:

• GSP Microcost Summary: bioinformatics cost for whole exome protocol 11 was updated
• NSCLC Health Economic Model: changed off label use of drugs to clinical trial use
• NSCLC Health Economic Model: modified default cost of GSP to $700, which is the average cost of 5-50 gene panel in the microcosting summary sheet
• Hearing loss Health Economic Model: changed plan size to 1 million
• Whole Exome Sequencing (WES) model: modified default cost of WES to $2439, which is the average WES cost in the microcosting summary sheet
• Microcost Template Model: unchanged

The JMD paper, which summarizes the results of this project is available here:
http://jmd.amjpathol.org/article/S1525-1578%2816%2900053-2/fulltext

The models are available at no charge. Upon download, you will be asked to fill out your contact information and agree to the terms and conditions of use. All models will then be downloaded in a zip file. The models that will be downloaded are:

Questions? Please contact AMP at policy@amp.org.