9 in 10 Korean cancer specialists believe NGS testing is ‘essential’

Precision medicine has made significant advances in the field of cancer treatment. Technologies, including genomic analysis, molecular diagnostics, immunotherapy, targeted therapies, big data and artificial intelligence, and precision radiotherapy, enable the individualization of cancer treatment and significantly contribute to improving patient survival and quality of life.

Among them, genomic analysis plays a key role in identifying the cause of an individual's cancer and customizing treatment strategies accordingly. As targeted and immuno-oncology drugs are anticancer drugs that target mutated genes that cause cancer, it is essential to find tumor-mutated genes in the body through genetic analysis tests. Therefore, Next Generation Sequencing (NGS) testing is no longer an option but a necessity in cancer treatment.

In 2017, the government designated NGS gene panel testing as a 50 percent conditional copayment item and applied it to reimbursement. This allowed Korean cancer patients to receive NGS tests for about 700,000 won ($506) per test.

However, in December of last year, the Ministry of Health and Welfare (MOHW) reduced the selective benefit through a notice related to next-generation sequencing (NGS)-based gene panel testing (Partial Revision of the Details on the Application Standards and Methods of Medical Treatment Benefits: MOHW Notification No. 2023-226).

While the 50 percent out-of-pocket payment rate was maintained for patients with advanced, metastatic, or recurrent lung adenocarcinoma, the ministry increased the rate to 80 percent for patients with other advanced, metastatic, or recurrent solid cancers (excluding lung adenocarcinoma), plasmacytoma, acute myeloid leukemia, acute lymphocytic leukemia, myelodysplasia, myeloproliferative tumors, malignant lymphoma, and hereditary diseases.

When the revision was announced, opinions were divided among cancer experts in Korea.

Many criticized the government's policy direction for running counter to global trends and clinical needs while some said the revision was necessary because the existing screening payment standards were not cost-effective for other cancers except lung cancer.

However, according to a survey conducted by the Korean Doctors’ Weekly, a sister paper of Korea Biomedical Review, on members of the Korean Cancer Association (KCA), most cancer experts in Korea have negative opinions about the revision.

The newspaper conducted an online survey of 200 members of the Korean Cancer Association from June 3 to 5 on the proposed revision of the selective benefit for NGS tests. The survey was composed of multiple-choice and some essay questions and 200 KCA members responded to the opinion poll.

As the KCA is a multidisciplinary organization, members from various specialties, including internal medicine, surgery, pathology, radiology, diagnostic laboratory medicine, and basic medicine, participated in the survey.

First, the overwhelming majority of respondents (89.5 percent) agreed that NGS testing is "essential" at this point.

When asked, "Do you think NGS testing is a necessary test for diagnosing and treating cancer patients at this point?" 90 respondents answered "very essential," 89 answered "essential", 17 answered "so-so," four answered "not much necessary," and no respondents answered, "not necessary at all."

On the other hand, when asked, "Do you think there is adequate policy support for NGS testing for cancer (e.g., test coverage, patient cost, etc.)?" far more than half (61.5 percent) of the respondents answered that the government's current support is not adequate -- “inadequate” (110 respondents), “so-so” (52), “adequate” (20), “very inadequate” (13), and “very adequate” (five).

Eighty-three percent (166 in 200) of respondents answered negatively to the revision of NGS screening reimbursement, and only 10 percent (20/200) answered positively, indicating that Korean cancer experts believe there is a lot of room for improvement in NGS screening reimbursement in the future.

When asked, "How do you feel about this revision?” 59 respondents replied "very negative," 107 said "negative," (107) with the remainder 17 saying "positive," (17), "14 saying “not much impact," and three saying, "very positive."

Notably, those who voted "negative" (166 respondents) said that copayment should not be increased to "ensure access to effective treatments (140)," "expand coverage for patients with advanced cancer (103)," "increase efficiency by testing multiple genes at once (reducing unnecessary testing (80," "improve the accuracy of diagnosis and treatment (74)," and "foster related industries and advance the future of medicine (63) in the multiple-reply question.

On the other hand, those who answered "positive" or "not much impact" (34 respondents) said the reason for increasing patients’ out-of-pocket payment was "to curb over-prescription (17 respondents), "to save health insurance funds (16)," "the number of clinically beneficial patients is small (11)," and "because NGS testing is not cost-effective” (nine).

When asked, "What do you think could be improved in the current reimbursement policy for NGS testing?" the majority of respondents (110) said, "to improve the cost-sharing structure."

The remaining responses were "refine the list of covered conditions (50), "expand the number of tests (10)," and "improve access (26). Other comments included expanding the number of available sites and tests.

In addition, when asked, "What do you think the ideal cost of NGS testing for cancer patients should be?" 74.5 percent (149 in 200) of respondents said that the cost should be lowered even further, with 92 respondents presenting 30 percent as the ideal copayment level, followed by 5 percent (57 respondents), 50 percent (42), and 100 percent (four).

Among “other” opinions was that it should be differentiated by cancer type based on clinical utility.

The survey results echoed the voices of cancer experts who say that NGS tests play an important role in cancer treatment and should be supported by more aggressive policies.

It also suggested that governments should consider these opinions and revisit their policies to make NGS testing more accessible and less burdensome for patients.