abstract
BACKGROUND:
With
increased demand for hereditary cancer genetic testing, some large
national health-care insurance payers (LNHPs) have implemented policies
to minimize inappropriate testing by mandating consultation with a
geneticist or genetic counselor (GC). We hypothesized such a restriction
would reduce access and appropriate testing.
METHODS:
Test
cancellation rates (ie, tests ordered that did not result in a reported
test result), mutation-positive rates, and turnaround times for
comprehensive BRCA1/2 testing for a study LNHP that implemented a
GC-mandate policy were determined over the 12 months before and after
policy implementation (excluding a 4-month transition period).
Cancellation rates were evaluated based on the reason for cancellation,
National Comprehensive Cancer Network testing criteria, and
self-identified ancestry. A control LNHP was evaluated over the same
period for comparison.
RESULTS:
The
study LNHP cancellation rate increased from 13.3% to 42.1% ( P <
.001) after policy implementation. This increase was also observed when
only individuals who met National Comprehensive Cancer Network criteria
for hereditary breast and ovarian cancer testing were considered (9.5%
to 37.7%; P < .001). Cancellation rates increased after policy
introduction for all ancestries; however, this was more pronounced among
individuals of African or Latin American ancestry, for whom
cancellation rates rose to 48.9% and 49.6%, respectively, compared with
33.9% for individuals of European ancestry. Over this same time period,
control LNHP cancellation rates decreased or stayed the same for all
subgroups.
CONCLUSION:
These
findings demonstrate that a GC-mandate policy implemented by a LNHP
substantially decreased access to appropriate genetic testing,
disproportionately impacting minority populations without any evidence
that inappropriate testing was decreased.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.