| During the next decade, ARK believes that multi-cancer earlier detection (MCED) tests will transform oncology. As we have written previously, MCED tests have the potential to shift the stage-at-diagnosis from metastatic toward localized disease. Public and private payers, however, are unlikely to reimburse MCED screening until 2024 or 2025 when companies will have published trial data supporting the clinical utility of such tests. Prior to FDA authorization and payer reimbursements, some MCED companies plan to market their tests to self-insured employers. Conceptually, self-insured employers should shoulder the financial risk of paying for their employees’ medical expenses, including innovative healthcare offerings such as MCED tests, by curating healthcare benefits relevant to their employees. As illustrated by a recent Aon (AON) and Accolade (ACCD) study, self-insured employers have been laser-focused on reducing healthcare spending per employee in the face of inexorable increases in insurance premiums. While MCED screening could save employer costs over the long-term, other monetary and psychological consequences also should be considered. Because cancer is so rare in the baseline population, MCED tests probably would identify an equal number of true-positives and false-positives, forcing employers to pay for unnecessary follow-up diagnostic tests. For patients diagnosed with cancer as a result of MCED screening, employers probably will not be able to distinguish between life-extension imparted by earlier treatment and lead-time bias, making it more challenging to quantify MCED benefits. Moreover, because the employee turnover rate in the US averages five years, employers adopting MCED tests could incur costs for diagnosing and treating cancers that, at less progressive companies, would not occur until later in life. |