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Int J Technol Assess Health Care. 2017 Jan;33(4):534-540. doi: 10.1017/S0266462317000903. Epub 2017 Oct 25.

EXAMINING EVIDENCE IN U.S. PAYER COVERAGE POLICIES FOR MULTI-GENE PANELS AND SEQUENCING TESTS.

Author information

1
Center for the Evaluation of Value and Risk in Health,Institute for Clinical Research and Health Policy Studies,Tufts Medical Center,Tufts University School of Medicinejchambers@tuftsmedicalcenter.org.
2
Center for the Evaluation of Value and Risk in Health,Institute for Clinical Research and Health Policy Studies,Tufts Medical Center.
3
American Institutes for Research,Department of Research and Evaluation.
4
University of California at San Francisco,Department of Clinical Pharmacy.

Abstract

OBJECTIVES:

The aim of this study was to examine the evidence payers cited in their coverage policies for multi-gene panels and sequencing tests (panels), and to compare these findings with the evidence payers cited in their coverage policies for other types of medical interventions.

METHODS:

We used the University of California at San Francisco TRANSPERS Payer Coverage Registry to identify coverage policies for panels issued by five of the largest US private payers. We reviewed each policy and categorized the evidence cited within as: clinical studies, systematic reviews, technology assessments, cost-effectiveness analyses (CEAs), budget impact studies, and clinical guidelines. We compared the evidence cited in these coverage policies for panels with the evidence cited in policies for other intervention types (pharmaceuticals, medical devices, diagnostic tests and imaging, and surgical interventions) as reported in a previous study.

RESULTS:

Fifty-five coverage policies for panels were included. On average, payers cited clinical guidelines in 84 percent of their coverage policies (range, 73-100 percent), clinical studies in 69 percent (50-87 percent), technology assessments 47 percent (33-86 percent), systematic reviews or meta-analyses 31 percent (7-71 percent), and CEAs 5 percent (0-7 percent). No payers cited budget impact studies in their policies. Payers less often cited clinical studies, systematic reviews, technology assessments, and CEAs in their coverage policies for panels than in their policies for other intervention types. Payers cited clinical guidelines in a comparable proportion of policies for panels and other technology types.

CONCLUSIONS:

Payers in our sample less often cited clinical studies and other evidence types in their coverage policies for panels than they did in their coverage policies for other types of medical interventions.

KEYWORDS:

Evidence; Multi-gene panels and sequencing tests; Payer coverage policies

PMID:
29065945
PMCID:
PMC5732073
DOI:
10.1017/S0266462317000903
[Indexed for MEDLINE]
Free PMC Article

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