Table 2.

Description of some case scenarios in which timing of testing and treatment departed from recommendations

Diagnosis	Clinical scenario
Diagnosed with squamous cell carcinoma in 2012	EGFR test was not performed. Erlotinib (100 mg) was prescribed in 2014. Three weeks later, erlotinib was put on hold due to side effects (skin rash and itching), and restarted after another month. Proteomic testing was done 5 weeks later, and the result of test was “Poor”. The physician made the decision to discontinue erlotinib. The patient received erlotinib for the total of 63 days (prescription for 3 months’ supply).
Diagnosed with adenocarcinoma in 2010	EGFR test was not performed. Erlotinib (150 mg) was prescribed for the patient in 2013. The proteomic test was done two weeks after the erlotinib prescription. The result of the proteomic test was “Poor”. The patient continued to take Erlotinib. The patient received erlotinib for 28 days (1 month’s supply).
Diagnosed with squamous cell carcinoma in 2013	EGFR test was performed at diagnosis. Result was negative. Patient's lung cancer progressed. Erlotinib was prescribed in 2014. At the same time, the proteomic test was ordered. Proteomic test results were received six weeks after erlotinib prescription. The test result was Good.
Diagnosed outside the VA, with metastatic adenocarcinoma	No EGFR test results available. Physician ordered VeriStrat in 2015. The result was “Poor”. Physician conducted a biopsy and ordered EGFR test 2 months after proteomic test results were reported. EGFR test was negative. Erlotinib was never prescribed.
Relevant costs
EGFR test: $500
Proteomic test: $2,112
Erlotinib, 100 mg tablets, 1 month’s supply: $4,815

Analysis of VA administrative data as of August 2015