ASCO Clinical Practice Guidelines: Past, Present and Future

Health technology assessment and private payers' coverage of personalized medicine

PURPOSE

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.

STUDY DESIGN

Literature review and semistructured interviews.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

National Cancer Institute partnerships in quality-of-care research

BACKGROUND

Improving the quality of cancer care delivery is a research priority for the National Cancer Institute (NCI). The NCI addresses this priority in part through a variety of research partnerships with public and private organizations designed to measure, monitor, and improve the quality of cancer care delivery.

METHODS

NCI-sponsored quality-of-care initiatives are reviewed in three areas: improving process and outcome measures, building strong data infrastructures to monitor the quality of cancer care, and developing practice-based quality-of-care research partnerships for privately sponsored and government-sponsored delivery programs.

RESULTS

Research partnerships strengthen the overall portfolio of NCI-sponsored research into understanding and improving cancer care delivery. These partnerships have made significant contributions in standardizing metrics of clinical effectiveness and health-related quality of life, in developing monitoring systems to track disparities in cancer care and identify opportunities for improvement, and in understanding ways to intervene in cancer care delivery to improve adherence to evidence-based practice. These partnerships also contribute to the productivity of investigator-initiated quality-of-care studies and often provide leverage for rapid adoption of this science by organizations that participate in these projects.

CONCLUSIONS

Research partnerships in measurement, data infrastructure, and service delivery are an essential part of the NCI's research program to advance the science of quality of cancer care. Collectively, these projects inform participating organizations on gaps in quality and opportunities for improving cancer care delivery. They also foster the development of tools for changing care processes that can lead to better outcomes for cancer patients and survivors.