Center for Translational and Policy Research in Personalized Medicine and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco; Center for Business Models in Healthcare, San Francisco, CA.
J Oncol Pract. 2011 May;7(3 Suppl):18s-24s. doi: 10.1200/JOP.2011.000300.
Health technology assessment (HTA) plays an increasing role in translating emerging technologies into clinical practice and policy. Private payers are important users of HTA whose decisions impact adoption and use of new technologies. We examine the current use of HTA by private payers in coverage decisions for personalized medicine, a field that is increasingly impacting oncology practice.
Literature review and semistructured interviews.
We reviewed seven HTA organizations used by private payers in decision making and explored how HTA is used by major US private payers (n = 11) for coverage of personalized medicine.
All payers used HTA in coverage decisions, but the number of HTA organizations used by an individual payer ranged from one (n = 1) to all seven (n = 1), with the majority of payers (n = 8) using three or more. Payers relied more extensively on HTAs for reviews of personalized medicine (64%) than for other technologies. Most payers (82%) equally valued expertise of reviewers and rigor of evaluation as HTA strengths, whereas genomic-specific methodology was less important. Key reported shortcomings were limited availability of reviews (73%) and limited inclusion of nonclinical factors (91%), such as cost-effectiveness or adoption of technology in clinical practice.
Payers use a range of HTAs in their coverage decisions related to personalized medicine, but the current state of HTA to comprehensively guide those decisions is limited. HTA organizations should address current gaps to improve their relevance to payers and clinicians. Current HTA shortcomings may also inform the national HTA agenda.
健康技术评估（HTA）在将新兴技术转化为临床实践和政策方面发挥着越来越重要的作用。私人支付者是 HTA 的重要使用者，他们的决策影响新技术的采用和使用。我们考察了私人支付者在个性化医疗覆盖决策中当前对 HTA 的使用情况，这是一个越来越影响肿瘤学实践的领域。
文献回顾和半结构化访谈。
我们回顾了私人支付者在决策中使用的七种 HTA 组织，并探讨了美国主要私人支付者（n=11）如何使用 HTA 来覆盖个性化医疗。
所有的支付者都在覆盖决策中使用 HTA，但个别支付者使用的 HTA 组织数量从一个（n=1）到所有七个（n=1）不等，大多数支付者（n=8）使用三个或更多。支付者在个性化医学（64%）的审查中比其他技术更广泛地依赖 HTA。大多数支付者（82%）同样重视评审员的专业知识和评估的严谨性，将其视为 HTA 的优势，而基因组特异性方法则不太重要。报告的主要缺点是审查的可用性有限（73%），以及非临床因素（91%），如成本效益或技术在临床实践中的采用情况有限。
支付者在与个性化医疗相关的覆盖决策中使用了一系列 HTA，但目前全面指导这些决策的 HTA 状况有限。HTA 组织应解决当前的差距，以提高其对支付者和临床医生的相关性。当前 HTA 的缺点也可能为国家 HTA 议程提供信息。
