商业保险支付人的参考资料不实质性覆盖拒绝骨科应用的干细胞治疗
Jacob L Kotlier1, Amir Fathi1, Meng-Yung Ong1
1Keck School of Medicine of USC, Los Angeles, CA, USA.
概括
保险公司经常拒绝使用低级别证据对骨科介质干细胞 (MSC) 治疗的保险. 然而,更高级别的研究表明,MSCs可能对膝关节和脊柱疾病有效.
科学领域:
- 整形外科 整形外科 整形外科
- 再生医学是一种再生医学.
- 医疗保险政策 医疗保险政策
背景情况:
- 再生疗法在治疗骨科疾病方面表现有前途.
- 这些疗法越来越受欢迎,导致保险覆盖被拒绝.
- 否认影响患者,医生,医院和付款人.
研究的目的:
- 分析商业付款人用于拒绝整形外科医生干细胞治疗 (MSC) 覆盖范围的参考资料.
- 了解有关骨科MSC应用的保险政策的基础.
主要方法:
- 审查了11个国家顶级商业支付者对骨科MSC治疗的政策.
- 分析了证据水平 (LOE),解剖位置和MSC类型的支持参考资料.
- 定义低LOE为不符合I或II级证据的研究.
- 以二进制的方式评估治疗疗效.
主要成果:
- 审查的5个付款人主要引用了IV级证据来拒绝覆盖.
- 支持MSC疗效的I级和II级证据是可用的,但往往没有被引用.
- 膝盖和脊柱是最受研究的位置,较高的LOE研究显示出有利的结果.
- 主要的期刊文章和更高的LOE研究报告了更有利的结果.
结论:
- 商业支付者主要使用低级别的证据来否认骨科MSC治疗的覆盖范围.
- 当考虑更高层次的证据时,通常表明MSCs的潜在有效性.
- 这表明现有的科学证据和保险覆盖决定之间存在差距.
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