An article in the American Journal of Managed Care reveals most research on the economic value of genetic testing in breast cancer relies on modeling instead of the insurer-preferred real-world modeling, according to a news release.
In the December AJMC article, Robert D. Lieberthal, PhD, representing the Jefferson Population Health Continuing Professional Education Collaborative in Philadelphia, found that while models have merit, they also have limits.
With breast cancer costing the nation $13.9 billion a year, Lieberthal writes its time for the nations insurers and other payers of healthcare to demand financial support for gathering data from
The article indicates economic models show using genetic tests in breast cancer treatment can save money and improve patients lives, but some insurers are reluctant to pay for tests without
Lieberthals article, Economics of Genetic Testing for Breast Cancer, reviews available research on whether the cost of genetic tests, which average about $3,400, are outweighed by the economic benefits of their use. The rise of specialized medicine allows clinicians to tailor treatment to the specifics of a womans breast cancer. This results in fewer adverse events, which can require their own treatment or hospitalization. One study pegged the cost of such events at $2,000 per patient and thats not counting the toll for those who suffer nausea or hair loss from being overmedicated.
Genetic tests also can reveal which women need ongoing therapy after an initial bout of cancer to keep it from returning, and tests can determine what that treatment should be.
Addresssing a quandary
Lieberthals call for more real-world research on the economic benefits of testing addresses a quandary in medicine in that payers dont want to cover tests or treatments that are unproven, but proof is difficult unless patients receive treatment.
The cooperation of multiple stakeholders will be essential if genomic medicine is to reach its full potential, Leiberthal writes. The barrier to progress for genomic medicine is the lack of empirical evidence for the clinical utility and value of genomic testing.
Support for real-world studies, from either public or private sources, could not only increase the likelihood that insurers will pay for tests, but also improve the use of testing over time.To review the full article, visit http://www.ajmc.com/publications/issue/2013/2013-1-vol19-n12/Economics-of-Genomic-Testing-for-Women-With-Breast-Cancer