Stakeholder perspectives on decision-analytic modeling frameworks to assess genetic services policy

Area of Science:

• Health Services Research
• Genetic Services Evaluation
• Decision Analysis

Background:

• Policymakers and insurers face challenges in genetic services coverage due to incomplete clinical utility data and budget limitations.
• Current methods for evaluating insurance coverage of genetic services are often unsatisfactory for stakeholders.

Purpose of the Study:

• To assess stakeholder opinions on using decision-analytic modeling (DAM) for genetic services coverage decisions.
• To identify genetic tests suitable for DAM studies.

Main Methods:

• An overview of DAM was presented to genetic services policymakers, insurers, and state Medicaid representatives.
• Directed content analysis and an anonymous survey were used to evaluate attitudes toward DAM.
• Participants prioritized genetic services for future DAM evaluations.

Main Results:

• Stakeholders expressed dissatisfaction with existing genetic services coverage evaluation processes.
• While some uncertainty about DAM comprehension existed, all stakeholders were open to its use.
• Interest was highest for applying DAM to multi-disorder testing, including next-generation sequencing and chromosomal microarray.

Conclusions:

• Decision-analytic modeling presents a valuable potential decision tool for genetic services stakeholders.
• This approach could aid Medicaid decision-makers in navigating complex coverage issues for genetic services.