Genetic Counseling for Cancer Often Costs Patients Nothing

Pam Harrison

August 08, 2022

Fewer than one third of cancer patients pay out-of-pocket costs for genetic counseling services.

But even among those who do, the cost is $16 or less, a cohort study shows.

"The findings highlight the relatively low financial costs of genetic counseling, a form of care with potentially substantial implications for cancer treatment," lead author Mya Roberson, PhD, Vanderbilt University School of Medicine, Nashville, Tennessee, and colleagues explain.

The study was published online July 29 in JAMA Health Forum.

Genetic counseling is an important feature of cancer care that can affect treatment decisions and surveillance. But coverage of genetic counseling services varies across insurance types.

To understand the costs to patients, the investigators used data from IBM Watson Health MarketScan to create a cohort of privately insured patients with breast, prostate, endometrial, ovarian, colorectal, and pancreatic cancer who had at least one genetic counseling session from 2013 to the end of 2019.

Roberson and colleagues then calculated out-of-pocket costs — including coinsurance, copayments, and deductibles — and total costs paid on claims for genetic counseling encounters. The cohort included 16,791 patients, the majority of whom had breast cancer.

Although the median insurance payment for genetic counseling encounters was $118 ($58 to $211), most patients paid nothing out of pocket for these services. Among the 31% of patients with an out-of-pocket expense, the cost was $16 or less.

Compared with breast cancer patients, men with prostate cancer were 28% more likely to have out-of-pocket costs for genetic counseling, which may "reflect a lack of awareness about the medical necessity of genetic counseling," the authors suggest.

Overall, the study highlights the value of genetic counseling in cancer care.

"Cancer genetic counseling not only promotes informed decision-making about genetic testing and cancer treatment in the era of precision medicine, but it also is a form of low-cost, high-value care," the authors write.

The study was funded by a grant from the National Cancer Institute. Roberson has disclosed no relevant financial relationships.

JAMA Health Forum. Published online July 29, 2022. Full text

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