What do providers, payers and patients need from comparative effectiveness research on diagnostics? the case of HER2/Neu testing in breast cancer

Julia R. Trosman, Christine B. Weldon, Julian C. Schink, William J Gradishar, Al B Benson III*

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Aims: Comparing effectiveness of diagnostic tests is one of the highest priorities for comparative effectiveness research (CER) set by the Institute of Medicine. Our study aims to identify what information providers, payers and patients need from CER on diagnostics, and what challenges they encounter implementing comparative information on diagnostic alternatives in practice and policy. Materials & methods: Using qualitative research methods and the example of two alternative protocols for HER2 testing in breast cancer, we conducted interviews with 45 stakeholders: providers (n = 25) from four academic and eight nonacademic institutions, executives (n = 13) from five major US private payers and representatives (n = 7) from two breast cancer patient advocacies. Results: The need for additional scientific evidence to determine the preferred HER2 protocol was more common for advocates than payers (100 vs 54%; p = 0.0515) and significantly more common for advocates than providers (100 vs 40%; p = 0.0077). The availability of information allowing assessment of the implementation impact from alternative diagnostic protocols on provider institutions may mitigate the need for additional scientific evidence for some providers and payers (24 and 46%, respectively). The cost-effectiveness of alternative protocols from the societal perspective is important to payers and advocates (69 and 71%, respectively) but not to providers (0%; p = 0.0001 and p = 0.0001). The lack of reporting laboratory practices is a more common implementation challenge for payers and advocates (77 and 86%, respectively) than for providers (32%). The absence of any mechanism for patient involvement was recognized as a challenge by payers and advocates (69 and 100%, respectively) but not by providers (0%; p = 0.0001 and p = 0.0001). Conclusion: Comparative implementation research is needed to inform the stakeholders considering diagnostic alternatives. Transparency of laboratory practices is an important factor in enabling implementation of CER on diagnostics in practice and policy. The incongruent views of providers versus patient advocates and payers on involving patients in diagnostic decisions is a concerning challenge to utilizing the results of CER.

Original languageEnglish (US)
Pages (from-to)461-477
Number of pages17
JournalJournal of Comparative Effectiveness Research
Volume2
Issue number4
DOIs
StatePublished - Jul 1 2013

Fingerprint

Comparative Effectiveness Research
Breast Neoplasms
Patient Participation
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Qualitative Research
Routine Diagnostic Tests
Causality
Cost-Benefit Analysis
Interviews
Research

Keywords

  • HER2 testing
  • alternative diagnostic protocols
  • comparative effectiveness research
  • coverage and reimbursement
  • diagnostics
  • implementation research
  • personalized medicine

ASJC Scopus subject areas

  • Health Policy

Cite this

@article{73515b2b7134412fa50554954b466055,
title = "What do providers, payers and patients need from comparative effectiveness research on diagnostics? the case of HER2/Neu testing in breast cancer",
abstract = "Aims: Comparing effectiveness of diagnostic tests is one of the highest priorities for comparative effectiveness research (CER) set by the Institute of Medicine. Our study aims to identify what information providers, payers and patients need from CER on diagnostics, and what challenges they encounter implementing comparative information on diagnostic alternatives in practice and policy. Materials & methods: Using qualitative research methods and the example of two alternative protocols for HER2 testing in breast cancer, we conducted interviews with 45 stakeholders: providers (n = 25) from four academic and eight nonacademic institutions, executives (n = 13) from five major US private payers and representatives (n = 7) from two breast cancer patient advocacies. Results: The need for additional scientific evidence to determine the preferred HER2 protocol was more common for advocates than payers (100 vs 54{\%}; p = 0.0515) and significantly more common for advocates than providers (100 vs 40{\%}; p = 0.0077). The availability of information allowing assessment of the implementation impact from alternative diagnostic protocols on provider institutions may mitigate the need for additional scientific evidence for some providers and payers (24 and 46{\%}, respectively). The cost-effectiveness of alternative protocols from the societal perspective is important to payers and advocates (69 and 71{\%}, respectively) but not to providers (0{\%}; p = 0.0001 and p = 0.0001). The lack of reporting laboratory practices is a more common implementation challenge for payers and advocates (77 and 86{\%}, respectively) than for providers (32{\%}). The absence of any mechanism for patient involvement was recognized as a challenge by payers and advocates (69 and 100{\%}, respectively) but not by providers (0{\%}; p = 0.0001 and p = 0.0001). Conclusion: Comparative implementation research is needed to inform the stakeholders considering diagnostic alternatives. Transparency of laboratory practices is an important factor in enabling implementation of CER on diagnostics in practice and policy. The incongruent views of providers versus patient advocates and payers on involving patients in diagnostic decisions is a concerning challenge to utilizing the results of CER.",
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author = "Trosman, {Julia R.} and Weldon, {Christine B.} and Schink, {Julian C.} and Gradishar, {William J} and {Benson III}, {Al B}",
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What do providers, payers and patients need from comparative effectiveness research on diagnostics? the case of HER2/Neu testing in breast cancer. / Trosman, Julia R.; Weldon, Christine B.; Schink, Julian C.; Gradishar, William J; Benson III, Al B.

In: Journal of Comparative Effectiveness Research, Vol. 2, No. 4, 01.07.2013, p. 461-477.

Research output: Contribution to journalArticle

TY - JOUR

T1 - What do providers, payers and patients need from comparative effectiveness research on diagnostics? the case of HER2/Neu testing in breast cancer

AU - Trosman, Julia R.

AU - Weldon, Christine B.

AU - Schink, Julian C.

AU - Gradishar, William J

AU - Benson III, Al B

PY - 2013/7/1

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N2 - Aims: Comparing effectiveness of diagnostic tests is one of the highest priorities for comparative effectiveness research (CER) set by the Institute of Medicine. Our study aims to identify what information providers, payers and patients need from CER on diagnostics, and what challenges they encounter implementing comparative information on diagnostic alternatives in practice and policy. Materials & methods: Using qualitative research methods and the example of two alternative protocols for HER2 testing in breast cancer, we conducted interviews with 45 stakeholders: providers (n = 25) from four academic and eight nonacademic institutions, executives (n = 13) from five major US private payers and representatives (n = 7) from two breast cancer patient advocacies. Results: The need for additional scientific evidence to determine the preferred HER2 protocol was more common for advocates than payers (100 vs 54%; p = 0.0515) and significantly more common for advocates than providers (100 vs 40%; p = 0.0077). The availability of information allowing assessment of the implementation impact from alternative diagnostic protocols on provider institutions may mitigate the need for additional scientific evidence for some providers and payers (24 and 46%, respectively). The cost-effectiveness of alternative protocols from the societal perspective is important to payers and advocates (69 and 71%, respectively) but not to providers (0%; p = 0.0001 and p = 0.0001). The lack of reporting laboratory practices is a more common implementation challenge for payers and advocates (77 and 86%, respectively) than for providers (32%). The absence of any mechanism for patient involvement was recognized as a challenge by payers and advocates (69 and 100%, respectively) but not by providers (0%; p = 0.0001 and p = 0.0001). Conclusion: Comparative implementation research is needed to inform the stakeholders considering diagnostic alternatives. Transparency of laboratory practices is an important factor in enabling implementation of CER on diagnostics in practice and policy. The incongruent views of providers versus patient advocates and payers on involving patients in diagnostic decisions is a concerning challenge to utilizing the results of CER.

AB - Aims: Comparing effectiveness of diagnostic tests is one of the highest priorities for comparative effectiveness research (CER) set by the Institute of Medicine. Our study aims to identify what information providers, payers and patients need from CER on diagnostics, and what challenges they encounter implementing comparative information on diagnostic alternatives in practice and policy. Materials & methods: Using qualitative research methods and the example of two alternative protocols for HER2 testing in breast cancer, we conducted interviews with 45 stakeholders: providers (n = 25) from four academic and eight nonacademic institutions, executives (n = 13) from five major US private payers and representatives (n = 7) from two breast cancer patient advocacies. Results: The need for additional scientific evidence to determine the preferred HER2 protocol was more common for advocates than payers (100 vs 54%; p = 0.0515) and significantly more common for advocates than providers (100 vs 40%; p = 0.0077). The availability of information allowing assessment of the implementation impact from alternative diagnostic protocols on provider institutions may mitigate the need for additional scientific evidence for some providers and payers (24 and 46%, respectively). The cost-effectiveness of alternative protocols from the societal perspective is important to payers and advocates (69 and 71%, respectively) but not to providers (0%; p = 0.0001 and p = 0.0001). The lack of reporting laboratory practices is a more common implementation challenge for payers and advocates (77 and 86%, respectively) than for providers (32%). The absence of any mechanism for patient involvement was recognized as a challenge by payers and advocates (69 and 100%, respectively) but not by providers (0%; p = 0.0001 and p = 0.0001). Conclusion: Comparative implementation research is needed to inform the stakeholders considering diagnostic alternatives. Transparency of laboratory practices is an important factor in enabling implementation of CER on diagnostics in practice and policy. The incongruent views of providers versus patient advocates and payers on involving patients in diagnostic decisions is a concerning challenge to utilizing the results of CER.

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KW - coverage and reimbursement

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KW - personalized medicine

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