TRANSPERS Publishes on Payer Coverage of “Liquid Biopsy” Tests, New UCSF Value & Access Program, and More

Letter from the Director

Happy summer from the not-so-summery, foggy San Francisco! We are delighted that TRANSPERS collaborators recently published several articles addressing current policy issues, including studies on payer coverage of “liquid biopsy” tests for early cancer detection and for treatment management. We are also proud to note the latest accomplishments of TRANSPERS collaborators, including awards and presentations at key conferences, and to highlight our increased collaboration with the UCSF-wide Precision Medicine Program.

Do you have an announcement you would like to see in our next newsletter? Let us know: [email protected].

Best,

Kathryn

Publications

New Publication Names Precision Medicine as one of 10 Health Policy Challenges for Next 10 Years

In a paper published in the inaugural issue of Health Affairs Scholar: Emerging and Global Health Policy, TRANSPERS Director Kathryn Phillips, PhD, and the editorial team describe ten critical health policy challenges, including requirements for precision medicine to reach its potential. Questions remain about the economic and societal value of using genomics, compared to other approaches; the impact on families of the identification of genetic variations that are inherited; the ethics of identifying the possibility of future disease in newborns and fetuses; access to testing for underserved populations; the lack of genomic data from non-white populations; the often contradictory preferences of individuals vs. society for genomic information; balancing innovation with affordability; regulatory conundrums; gaps in anti-discrimination legislation; and how approaches and policies compare across countries.

TRANSPERS Publishes First Systematic Assessment on Payers’ Evidence Needs for Coverage of “Liquid Biopsy” Early Cancer Detection Tests

In a paper published June 20 in Health Affairs Scholar: Emerging & Global Health Policy, Trosman et al report results from the first systematic assessment on the perspectives and evidence needs of U.S. private payers on insurance coverage for multicancer early detection (MCED) tests, also called “liquid biopsy” tests.

MCED tests are already on the market but not covered by most payers. We found that payers recognized the potential importance of MCED, particularly for cancers that lack screening tests. However, there were concerns about inclusion of cancers without a proven benefit from early diagnosis (74%), perceived high false-negative rates (53%), and the lack of evaluative protocols for unconfirmed cancers (53%). Most (58%) would accept surrogate endpoints versus mortality data, and 64% would accept rigorous real-world evidence versus an RCT.

Payers’ perspectives, concerns, and evidentiary needs should inform evidence development for MCED screening programs. In addition, private payers should be stakeholders of a national MCED policy agenda, including equity efforts and initiatives addressing workforce capacity for cancer detection and care.

TRANSPERS Study Finds Insurer Coverage Remains Variable for Blood-Based Tests for Cancer Management

Circulating tumor DNA testing for cancer patients (ctDNA), which uses blood rather than tissue for testing, is increasingly part of clinical care for initial targeted therapy, identifying therapeutic resistance, and measuring minimal residual disease (MRD) after treatment. However, a study by TRANSPERS collaborators in the Journal of the National Comprehensive Cancer Network (JNCCN) found that insurer coverage by private payers and Medicare remains variable.

Although coverage by private payers was common for ctDNA for initial treatment selection, there was more variability in coverage for testing for progression and MRD. Non-small cell lung cancer was the cancer type most frequently covered for initial treatment and progression. Of the 14 Medicare policies, most provided coverage for initial treatment selection and progression, but fewer provided coverage for MRD. Most policies restricted coverage to patients without available tissue, or if biopsy was contraindicated.

News

TRANSPERS Initiates UCSF-Wide Precision Medicine Value and Access Program

TRANSPERS has joined forces with the UCSF Precision Medicine Program (PMP) to initiate a UCSF-Wide “Precision Medicine Value and Access Program”. The PMP, led by Vice Chancellor Keith Yamamoto, has pioneered work in precision medicine across the full spectrum of approaches, including basic, clinical, and social science. The new Value and Access Program, led by TRANSPERS, brings together a broad spectrum of experts from UCSF and beyond to address critical issues that impact the effective translation of precision medicine innovations into practice and policy.

Emily Mrig Named UCSF Population Health and Health Equity Scholar

TRANSPERS collaborator Emily Mrig, PhD, was named a UCSF Population Health and Health Equity Scholar for her work on augmenting electronic health records data with geospatial data to address disparities across the continuum of precision oncology care. Emily is an interdisciplinary scholar dedicated to investigating and alleviating inequities in access to precision medicine and oncology care.

Grant Award and Transition to Kaiser Permanente for TRANSPERS Collaborator Meera Ragavan

We recently celebrated with Meera Ragavan, MD, a medical oncology fellow at UCSF and TRANSPERS fellow, who was awarded a Young Investigator Award from the American Society of Clinical Oncology (ASCO). These awards provide funding to promising investigators to encourage and promote quality research in clinical oncology. Her project is centered around promoting affordability and equity in cancer care delivery and on evaluating predictors of receipt of financial assistance and the impact of assistance programs on delays, interruptions, and disparities in cancer care.

We also congratulate Meera as she completes her training and moves to her new role as a research scientist in the Division of Research at Kaiser Permanente Northern California and a thoracic medical oncologist at Kaiser San Francisco. She will continue collaborating with TRANSPERS in her new role.

New Data Scientist Position at AbbVie for Cheng Chen

Post-doctoral scholar Cheng Chen, PhD, has started a new position as a health economics and outcomes research data scientist at AbbVie. Cheng joined TRANSPERS in 2021 and has played a pivotal role in multiple projects focused on exploring the value of liquid biopsy in guiding targeted therapy decisions for non-small cell lung cancer. She will continue collaborating with TRANSPERS to enhance the safety, effectiveness, and patient outcomes of oncology treatments.

Conferences

Kathryn Phillips at 2023 Precision Medicine World Conference

Center Director Kathryn Phillips, PhD, participated in a lively panel discussion on liquid biopsy tests for early cancer detection at the 2023 Precision Medicine World Conference.

Jeroen Jansen Leads Network Meta-Analysis Workshops at Annual ISPOR Conference

TRANSPERS collaborator Jeroen Jansen, PhD, led several workshops at the 2023 Annual ISPOR (The Professional Society for Health Economics and Outcomes Research) Conference. Participants learned about non-proportional hazards network meta-analysis methods and their application when developing cost-effectiveness models in oncology.

UCSF Health Services Research Symposium Highlights Research on Disparities

The first in-person UCSF Health Services Research Symposium on May 23 included a presentation by TRANSPERS collaborator Emily Mrig, PhD, that highlighted the burdens on underinsured patients using patient assistance programs for access to expensive healthcare services.