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Cost-Saving 40-GEP Test in ART Decision-Making Reduces Over-Treatment


The 40-GEP test could help patients with skin cancer avoid adjuvant radiation therapy while simultaneously saving millions in health care costs.



Utilizing the 40-gene expression profile (40-GEP) test to determine which patients with skin cancer will benefit most from adjuvant radiation therapy (ART) could result in significant healthcare savings while avoiding overtreatment, a new study has found.1 The study was funded by Castle Biosciences, Inc., the makers of the DecisionDx-SCC test.

Using medical claims data on US Medicare patients with new diagnoses of cutaneous squamous cell carcinoma (cSCC) in a 12-month period, the researchers analyzed 22,917 patients with cSCC who received ART. The goal was to determine if using the 40-GEP test to guide the use of ART among Medicare-eligible patients diagnosed with cSCC would reduce healthcare costs related to cSCC management.

The researchers calculated the weighted average direct cost for ART, including the 4 most-used CPT code-defined modalities (IGRT, IMRT, IMPT, and XRT), to be $60,693 per patient, amounting to an annual projected ART cost of $1.4 billion.

Using the 40-GEP test to avoid ART in these patients could save up to $972 million annually in this population, they determined.

The test may also ensure appropriate treatment levels among patients diagnosed with cSCC, the researchers concluded, pointing out that patients classified as high-risk or very high-risk “represent a broad range of actual metastatic risk, leading to over-treatment as well as under-treatment.” Most patients with cSCC who may be considered candidates for ART are metastasis-free without any additional intervention, they added.

The study results align with previous findings presented at the 2023 Fall Clinical Dermatology Conference.2 Those researchers concluded that 40-GEP was effective at identifying those patients with cSCC who:

  • will benefit from ART with improved metastasis-free survival and delay of nodal or distant metastasis
  • are less likely to benefit from ART in controlling metastatic disease progression, and 
  • will benefit from ART as a reduction in metastatic disease progression.

“Above and beyond the considerable cost savings is the potential to truly improve SCC patient care by using the test’s results to provide added confidence in decisions to forgo radiation therapy when a patient’s risk of metastasis is low,” said lead author Ally‐Khan Somani, MD, PhD, in a press release.3


  1. Somani A, Ibrahim SF, Tassavor M, Yoo J, Farberg AS. Use of the 40-gene expression profile (40-GEP) test in Medicare-eligible patients diagnosed with cutaneous squamous cell carcinoma (cscc) to guide adjuvant radiation therapy (ART) decisions leads to a significant reduction in healthcare costs. J Clin Aesthet Dermatol. 2024;17(1):41–44.
  2. Arron S, Cañueto J, Siegel J, et al. Association of a 40-gene expression profile (40-GEP) with risk of metastatic disease progression of cutaneous squamous cell carcinoma (cSCC) and benefit of adjuvant radiation therapy (ART). Presented at: 2023 Fall Clinical Dermatology Conference; October 19-22, 2023; Las Vegas, NV.
  3. New study highlights significant potential Medicare savings through use of Castle Biosciences’ DecisionDx®-SCC test to guide adjuvant radiation therapy decisions in patients with cutaneous squamous cell carcinoma. News release. Castle Biosciences. Accessed January 19, 2924. https://ir.castlebiosciences.com/news/news-details/2024/New-Study-Highlights-Significant-Potential-Medicare-Savings-Through-Use-of-Castle-Biosciences-DecisionDx-SCC-Test-to-Guide-Adjuvant-Radiation-Therapy-Decisions-in-Patients-with-Cutaneous-Squamous-Cell-Carcinoma/default.aspx
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