Conceptual Paper Proposes Four Cost-Reducing Interventions for In Vitro Diagnostics

Kelly Davio

US healthcare spending is on the rise, and is expected to comprise over 20% of the gross domestic product by 2025. Current expenditures are expected to double by 2060 if the pace of spending in the past decade continues. In this healthcare landscape, in vitro diagnostics (IVD) have increasingly become the subject of scrutiny, as IVDs are perceived as contributing to soaring costs. However, a conceptual paper, recently published in Swiss Medical Weekly, suggest that IVDs are currently underexploited and undervalued, and proposes 4 interventions that could contribute to increased effectiveness of IVD use to help counteract increasing healthcare expenditures.

Fostering prevention, screening, early diagnosis, and therapy
The paper’s authors report that the United Kingdom’s National Health Service (NHS) expends 2.5 times more on treatment for stage 3 and stage 4 colon, rectal, lung, and ovarian cancer treatment than it does on treatment for the same cancers at stage 1 and stage 2. Earlier diagnosis, they argue, could save up to 5% of the total UK treatment budget for these cancers. Earlier diagnosis was associated with longer survival in patients treated under the NHS, the authors point out, noting that it also has a positive effect on a patient’s quality of life during adjuvant chemotherapy.

Promoting comprehensive disease management
The authors point to experience with the Pap smear, which has a significant diagnostic false-negative rate that has resulted in annual testing and low thresholds for follow-up procedures. Such follow-up procedures, including colposcopy, are expensive and often unnecessary. An IVD that more accurately identifies patients who are at the highest risk for cervical cancer can maximize the benefits of screening while minimizing costs and potential harm. In Germany, using such a test reduced the annual incidence of cervical cancer by 30%, and reduced the total cost per patient screened per year by 7%.

Promoting stratified disease management
The researchers suggest that IVDs can help allocate patients to risk groups for either developing a certain disease or progressing toward a predicted outcome. In cardiology, where expenditures are increasing, the ability to diagnose and prognosticate worsening heart failure could help to prevent costly recurrent hospitalizations. In the United Kingdom, the National Institute for Health and Clinical Excellence has adopted measuring the N-terminal pro-brain natriuretic peptide biomarker as a rule-out test for heart failure to help limit unnecessary referrals for echocardiography.

Using targeted treatment alongside companion diagnostics
IVDs allow clinicians to identify patients who will benefit from, or potentially be harmed by, particular therapies as they develop personalized treatment plans. Tests like the HER2 IVD test, which identifies tumors that overexpress HER2, can be used to help avoid treating a patient with a costly agent (eg, trastuzumab [Herceptin]) if that agent is likely to be ineffective.

In order to make more appropriate use of IVDs, the authors suggest that fee-for-service delivery should be revised to emphasize the payer’s need for more effective patient management by rewarding specific outcome measures. The authors suggest that value tests be implemented as a way to contain costs and make sure that patients receive the most appropriate care.
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