Cost drivers of cancer sequencing technologies

Abstract Next-generation sequencing (NGS) is widely recommended for cancer diagnosis and monitoring, but is perceived as prohibitively expensive. Using Medicare reimbursement data and microcosting analysis in acute myeloid leukemia (AML), we find that sequencing alone costs less than the ~$1000 reimbursement, while library preparation ($12–$154/sample), driven by oligonucleotide synthesis, comprises an increasing share of cost. Expanding NGS access may depend more on cheaper library preparation and systems-level centralization.