Factors influencing health insurers' decisions to cover new genetic technologies.
Factors influencing health insurers' decisions to cover new genetic technologies.
复制标题
影响健康保险公司决定承保新基因技术的因素。
DOI：
10.1017/s026646230016115x
复制
发表时间：
2000
影响因子：
3.2
通讯作者：
Holtzman,NA
中科院分区：
文献类型：
--
作者：
Schoonmaker,MM;Bernhardt,BA;Holtzman,NA
目的探讨影响健康保险公司新基因技术覆盖的因素的相对重要性。方法进行一项全国性调查，询问私营健康保险公司的决策者是否会承担囊性纤维化（CF）携带者筛查、乳腺癌遗传易感性测试（BRCA测试）以及在各种情况下CF基因治疗临床试验的医疗费用。结果在研究进行时，应答者对这两种检测和临床试验医疗费用的覆盖率较低（占保险公司的4%-15.5%）。如果检测的人群仅限于高危人群，如果检出率更高，成本更低，如果检测得到国家专业团体或共识会议的认可，他们对CF携带者筛查和BRCA检测的覆盖率将显著增加。如果CF基因治疗试验仅限于患有严重CF的儿童或成人，安全性和有效性得到证实，并且治疗可以在地区医院或门诊环境中进行，而不是在研究医院进行，那么CF基因治疗试验的医疗费用报销将大大增加。结论健康保险公司在新基因技术的传播中起着关键作用。基因检测的有效性以及新疗法的安全性和有效性是影响健康保险公司承保范围的主要因素。较低的费用和专业团体的批准是增加覆盖面的其他因素。
ObjectiveTo examine the relative importance of factors influencing health insurers' coverage of new genetic technologies.MethodsA national survey in which the decision makers for private health insurers were asked whether they would cover cystic fibrosis (CF) carrier screening, testing for genetic susceptibility to breast cancer (BRCA test), and medical costs of a clinical trial of gene therapy for CF under a variety of conditions.ResultsRespondents' coverage of the two tests and of medical costs of clinical trials was low at the time of the study (4%–15.5% of insurers.) Their coverage of CF carrier screening and BRCA testing would be increased significantly if the group tested was restricted to those at high risk, if detection rates were higher and costs lower, and if testing was endorsed by a national professional group or consensus conference. Coverage of the medical costs of a trial of CF gene therapy would be significantly more likely if the trial was restricted to children or adults with severe CF, safety and effectiveness was proven, and therapy could be administered in a regional hospital or an outpatient setting rather than in a research hospital.ConclusionsHealth insurers play a critical role in the diffusion of new genetic technologies. The validity of genetic tests and the safety and effectiveness of new therapies are primary factors influencing health insurers' coverage. Lower costs and approval of professional groups are other factors associated with increased coverage.