Abstract
The UK National Health Service is paying for next-generation clinical tumor screening at the Oxford University Hospitals NHS Trust, a key step toward making the technology broadly available throughout the country.
Probing tumors in the clinic for potentially druggable targets has become easier with next-generation sequencing. However, access to that technology in the United States is stymied by reimbursement challenges, given that many payers still view it as experimental.
That's not the case in the UK, however. In March, the National Health Service (NHS) announced that it would pay for next-generation tumor screening at the Oxford University Hospitals NHS Trust. This collection of 4 hospitals located in and around the city of Oxford treats approximately 2,000 patients with cancer per year.
The NHS's decision marks a key step toward making the technology broadly available throughout the country, says Anna Schuh, MD, PhD, director of molecular diagnostics at the Oxford Biomedical Research Center (BRC), which is funded by the NHS's National Institute of Health Research. “That's what we're working towards.”
Priced at £300, or roughly $460, and run on an Ion Personal Genome Machine from Life Technologies, the 46-gene panel costs as much as the previous panel, which screened just 2 genes. The NHS decision to adopt it, Schuh says, was a “no-brainer.”
Patients with cancer will be treated and selected for clinical trials based on the results, which will be stored in a national database linked to clinical outcome data.
Eventually, the BRC, which developed and carries out the test, will offer a larger, government-supported panel of 150 genes, including new targets in early-stage drug development.
By adopting a single, NHS-sanctioned panel, the UK's approach to next-generation sequencing for clinical treatment differs markedly from that taken in the United States, where hospitals typically develop their own tests individually or buy them commercially.
Moreover, in the United States, no single government entity or professional association approves the tests, which vary substantially by location, explains Marilyn Li, MD, director of the Cancer Genetics Laboratory and professor of molecular and human genetics at Baylor College of Medicine in Houston, TX. Li's laboratory provides a 50-gene panel for use at Baylor's Dan L. Duncan Cancer Center, with plans for a much larger panel of 400 genes.
The more individualized approach in the United States offers flexibility with respect to meeting clinical demands, Li says. However, with government backing, it's likely that the technology will be adopted faster in the UK, she suggests.
“Our oncologists would very much like to offer next-generation sequencing to all our cancer patients,” Li says. “The only obstacle is payment.”
