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
Center for the Evaluation of Value and Risk in Health,Institute for Clinical Research and Health Policy Studies,Tufts Medical Center.
Int J Technol Assess Health Care. 2017 Jan;33(4):534-540. doi: 10.1017/S0266462317000903. Epub 2017 Oct 25.
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.
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.
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.
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.
本研究旨在考察支付方在其多基因panel 和测序检测（panel）覆盖政策中引用的证据，并将这些发现与支付方在其其他类型医疗干预覆盖政策中引用的证据进行比较。
我们使用加利福尼亚大学旧金山分校 TRANSPERS 支付者覆盖登记处，确定了五家最大的美国私人支付者发布的 panel 覆盖政策。我们审查了每项政策，并将引用的证据分为以下几类：临床研究、系统评价、技术评估、成本效益分析（CEA）、预算影响研究和临床指南。我们将这些 panel 覆盖政策中引用的证据与之前一项研究中报告的其他干预类型（药物、医疗器械、诊断测试和影像学、手术干预）的政策中引用的证据进行了比较。
共纳入 55 项 panel 覆盖政策。平均而言，支付方在 84%的覆盖政策中引用了临床指南（范围为 73%-100%），在 69%的政策中引用了临床研究（50%-87%），在 47%的政策中引用了技术评估（33%-86%），在 31%的政策中引用了系统评价或荟萃分析（7%-71%），在 5%的政策中引用了 CEA（0%-7%）。没有支付方在其政策中引用预算影响研究。支付方在其 panel 覆盖政策中较少引用临床研究、系统评价、技术评估和 CEA，而在其他干预类型的政策中则较多引用。支付方在 panel 和其他技术类型的政策中引用临床指南的比例相当。
在我们的样本中，支付方在其 panel 覆盖政策中较少引用临床研究和其他证据类型，而在其其他类型医疗干预覆盖政策中则较多引用。
