We often hear it takes five, or ten, or some other long period for medical innovations to be adopted.
In a new August 1 paper, Horgan et al. look specifically at the gap between achieving guideline recommendations, and being incorporated in policies (e.g. Medicare policies or Blue Cross policies) and utilization. The authors take a European perspective, comparing principally 11 countries, from UK and France to Croatia and Bulgaria.
https://www.degruyter.com/document/doi/10.1515/dx-2024-0092/html [not open access]
Since I work at exactly this intersection of guidelines, evidence, and payor decisions, I found the whole article worth reading. I can't make a better summary than the Chat GPT 4o summary, below.
See also Ignatiadis et al., 2024, specifically on disparities in European access to breast cancer innovative technologies - here.
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AI Corner
The paper titled "Bridging the divide: addressing discrepancies between clinical guidelines, policy guidelines, and biomarker utilization" by Denis Horgan and colleagues analyzes the discrepancies between clinical guidelines, policy guidelines, and the utilization of advanced diagnostic techniques in cancer care across multiple European countries. The primary focus is on next-generation sequencing (NGS) and liquid biopsy for cancers such as lung cancer, breast cancer, prostate cancer, and melanoma.
Key Findings:
Discrepancies in Implementation:
- Western Europe: Countries like Germany, France, the UK, and Sweden show high levels of implementation and adoption of clinical guidelines and biomarker utilization. These countries have well-developed infrastructures for biomarker testing and molecular diagnostics, supported by robust reimbursement policies.
- Eastern Europe: Countries like Poland, Hungary, Croatia, and Bulgaria lag significantly in the adoption and implementation of clinical guidelines and biomarker utilization. The infrastructure for advanced diagnostics in these regions is less developed, and reimbursement policies are less supportive.
Economic Factors:
- The utilization of advanced diagnostics is significantly influenced by economic factors, particularly in poorer countries. Countries like Croatia and Bulgaria face economic constraints that limit the adoption of new technologies and the implementation of comprehensive testing infrastructure.
- The paper highlights the need for better resource allocation and regional cooperation to improve access to advanced diagnostics in economically disadvantaged regions.
Policy Delays:
- Even in wealthier countries like France and Germany, policy changes and the integration of clinical guidelines into health policy decisions are slow. This delay is attributed to bureaucratic inertia and the slow pace of policy reforms despite clear recommendations from medical societies.
- The misalignment between clinical guidelines and policy guidelines leads to missed opportunities for optimizing patient care, even in countries with advanced healthcare systems.
Conclusion:
The delay in the utilization of advanced diagnostic techniques is due to a combination of economic constraints and tardy policy changes. In poorer countries like Croatia, economic factors are a significant barrier, whereas in wealthier countries like France and Germany, the slow integration of clinical guidelines into policy decisions is a major issue. The paper advocates for targeted policy reforms, improved resource allocation, and greater attention to the recommendations of medical societies to bridge these gaps and enhance cancer care across Europe.
What lessons can US policy experts take? We also see a gap between medical guidelines and payor policies, but my impression is, here, technologies endorsed in major, non-biased evidence based guidelies are often pretty quickly adopted by payors. Endorsements by smaller or medical-socieity-based guidelines (self interest concerns?) are adopted slower.
US policy experts can learn several valuable lessons from the findings and analysis presented in the paper regarding the discrepancies between clinical guidelines, policy guidelines, and biomarker utilization in Europe. Here are some key takeaways:
Lessons for US Policy Experts:
Alignment of Clinical and Policy Guidelines:
- Ensure that clinical guidelines endorsed by major, non-biased, evidence-based organizations are swiftly integrated into policy decisions. The delay in Europe shows the importance of aligning clinical recommendations with policy guidelines to optimize patient care.
- Encourage collaboration between clinical experts and policymakers to streamline the adoption process and reduce bureaucratic inertia.
Economic and Resource Allocation:
- Address economic disparities that can hinder the adoption of advanced diagnostics. Similar to the economic constraints seen in poorer European countries, the US has regions and healthcare providers with varying levels of resources.
- Consider targeted funding and incentives to support the adoption of advanced diagnostics in underserved areas. This could include grants, subsidies, or public-private partnerships to improve access to the latest technologies.
Evidence-Based Endorsements:
- Emphasize the importance of endorsements from major, unbiased evidence-based guidelines. In the US, technologies backed by such guidelines are adopted more quickly by payors, suggesting the need for guideline bodies to adopt rigorous and transparent evaluation processes.
- Exercise caution with smaller or self-interest-driven medical society guidelines. Ensure that any endorsements are based on robust evidence to avoid potential biases and conflicts of interest.
Infrastructure Development:
- Invest in the development of infrastructure necessary for advanced diagnostics, similar to the well-developed systems seen in countries like Germany and France.
- Focus on building comprehensive testing facilities, training healthcare providers, and ensuring the availability of necessary equipment to support widespread implementation of biomarker testing and molecular diagnostics.
Streamlined Reimbursement Processes:
- Develop clear and supportive reimbursement frameworks for advanced diagnostics. The European experience shows that supportive reimbursement policies facilitate broader adoption and integration of new technologies.
- Simplify the reimbursement process for healthcare providers to reduce administrative burdens and ensure timely access to innovative diagnostic tools.
Equitable Access to Diagnostics:
- Address disparities in access to advanced diagnostics across different regions and populations within the US. Similar to the "two Europes" scenario, there may be significant gaps in access that need to be bridged.
- Promote policies that ensure all patients, regardless of their geographic location or socioeconomic status, have access to the latest diagnostic technologies and personalized treatment options.
Monitoring and Continuous Improvement:
- Implement mechanisms to monitor the adoption and impact of new technologies continuously. This can help identify gaps, assess the effectiveness of policies, and make necessary adjustments.
- Encourage ongoing research and data collection to support evidence-based policy decisions and the continuous improvement of healthcare practices.
Conclusion:
By learning from the European experience, US policy experts can enhance the alignment between medical guidelines and payor policies, ensure equitable access to advanced diagnostics, and foster a healthcare environment that swiftly adopts evidence-based innovations. Addressing both economic and policy-related barriers will be crucial in achieving these goals and optimizing patient care.
