Abstract 1964: Racial and ethnic trends in next-generation sequencing (NGS) utilization among adult patients with selected advanced tumor types: a large commercial database analysis

Introduction: NGS utilization has increased over the last decade, although opportunities for improvement remain. Evaluation of trends in NGS utilization between race/ethnic groups will provide a better understanding of potential populations that may not have equitable access to NGS testing. Methods: Optum Clinformatics® Data Mart administrative health claims data was utilized to conduct a retrospective cohort study among US adult patients with >2 diagnostic ICD-10 codes for metastatic non-small cell lung cancer (mNSCLC), metastatic colorectal cancer (mCRC), metastatic breast cancer (mBC), metastatic melanoma (mM), or primary central nervous system (CNS) tumors indexed between 1/1/2015 - 3/31/2021. NGS tests were identified using Current Procedural Terminology and Proprietary Laboratory Analyses codes. Outcomes by race and tumor type included time to first NGS test, prevalence of testing across study period and for key guideline/therapy timeframes. Data were summarized descriptively for analyses outcomes. Results: A total of 14,620 mNSCLC, 9,538 mCRC, 26,086 mBC, 1,740 mM, and 5,835 CNS patients met the inclusion criteria. Of these, 3.4% were Asian, 12.1% were Black, 9.4% were Hispanic, 70.0% were White and 5.1% were missing race data. NGS use increased for all races over the study period (Table 1). Median time to testing from diagnosis across tumors ranged from 1.1-1.8 months (mo) for Asian patients, 1.4-5.6 mo for Black, 1.4-5.1 mo for Hispanic, 1.2-7.2 mo for White and improved over key timeframes and overall study period. Conclusions: Within a similar access system, NGS testing rates for minorities in mNSCLC, mCRC, mBC, mM, and primary CNS tumors have increased between 2015 and 2021 and appear comparable to the White population. This analysis suggests equitable access to health insurance in a commercially insured population can lead to equal access to NGS testing between races. Table 1 NGS Testing Prevalence by Race and Key Timeframes Tumor Type/Race 1/1/2015 - 8/31/2016 (prior to key policy changes and larotrectinib approval) 9/1/2016 - 3/31/2018 (UnitedHealthcare expansion of NGS testing) 4/1/2018 - 11/25/2018 (Centers for Medicare & Medicaid Services recommending NGS use in diagnostics) 11/26/2018 - 6/30/2021 (Food and Drug Administration approval of larotrectinib) Mnsclc Asian 1.2% 1.4% 10.0% 21.1% Black 3.3% 1.4% 12.9% 15.5% Hispanic 2.9% 1.4% 9.3% 13.9% White 3.5% 6.7% 9.8% 16.5% mCRC Asian 1.4% 0.0% 11.9% 9.5% Black 2.5% 2.1% 4.0% 11.2% Hispanic