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Dr Joseph Alvarnas Explains Barriers to Clinical Trial Diversity and Payer Participation


For the US health care system to be appropriately patient-centered, clinical trials need to be reflective of the country's diversity, said Joseph Alvarnas, MD, vice president of government affairs and senior medical director for employer strategy at City of Hope.

Joseph Alvarnas, MD, vice president of government affairs and senior medical director for employer strategy at City of Hope, talks about potential payer biases against experimental or investigational clinical trials and the payer's role in trial diversity.

Alvarnas served as cochair for The American Journal of Managed Care®'s 11th annual Patient-Centered Oncology Care® meeting.


What are some common payer barriers for participating in clinical trials?

Some of the challenges historically have been related to this idea of something being experimental or investigational. And this idea that you should pay for care that is established standard or that represents best practice is something that both payers and clinicians have embraced. But I think what makes cancer care different is that, for a significant percentage of patients that we serve, optimal care has yet to be identified. Or we have therapies that may work very well, but whose toxicities are not what we would want.

I think context is really important, and if we can engage payers in a discussion as to the value of a clinical trial, a well-designed, very appropriately constructed clinical trial that can actually answer specific clinical questions and potentially deliver value to patients, then I think we can reset this idea that experimental and investigational represents some irresponsible practice of medicine, where for many patients in the cancer care domain, it represents the top choice for best practice.

Why do payers have a stake in greater diversity in clinical trials?

Well, we're living in a nation that's becoming increasingly diverse, and there are 2 challenges in that increasing diversity. The first is we want to make sure that our health care system is appropriately patient-centered, and if you can't respect or integrate that level of emerging and growing diversity into how we deliver care, then you've already created a system that's not very good at delivering care to diverse populations or to the nation as a whole.

The other aspect of this is we don't know what we don't know. The beauty of clinical trials is we can identify new knowledge and new knowledge that's hopefully applicable to either an entire population or to subsets within that population. In the realm of knowing to what extent clinical trial findings are generalizable, we have to diversify who's enrolled in that trial, because we're not all biologically identical, and not all people are superimposable. So, if we can better understand the applicability of a clinical trial and the generalizability of those results, then it helps us to empower better decision-making after that trial is complete.

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