title: Improving the Efficiency and Quality of the Value Assessment Process for Companion Diagnostic Tests: The Companion test Assessment Tool (CAT).
abstract: BACKGROUND
  Companion diagnostic tests (CDTs) have emerged as a vital technology in the effective use of an increasing number of targeted drug therapies. Although CDTs can offer a multitude of potential benefits, assessing their value within a health technology appraisal process can be challenging because of a complex array of factors that influence clinical and economic outcomes.
  
  
  OBJECTIVE
  To develop a user-friendly tool to assist managed care and other health care decision makers in screening companion tests and determining whether an intensive technology review is necessary and, if so, where the review should be focused to improve efficiency.
  
  
  METHODS
  First, we conducted a systematic literature review of CDT cost-effectiveness studies to identify value drivers. Second, we conducted key informant interviews with a diverse group of stakeholders to elicit feedback and solicit any additional value drivers and identify desirable attributes for an evidence review tool. A draft tool was developed based on this information that captured value drivers, usability features, and had a particular focus on practical use by nonexperts. Finally, the tool was pilot tested with test developers and managed care evidence evaluators to assess face-validity and usability. The tool was also evaluated using several diverse examples of existing companion diagnostics and refined accordingly.
  
  
  RESULTS
  We identified 65 cost-effectiveness studies of companion diagnostic technologies. The following factors were most commonly identified as value drivers from our literature review: clinical validity of testing; efficacy, safety, and cost of baseline and alternative treatments; cost and mortality of health states; and biomarker prevalence and testing cost. Stakeholders identified the following additional factors that they believed influenced the overall value of a companion test: regulatory status, actionability, utility, and market penetration. These factors were used to maximize the efficiency of the evidence review process. Stakeholders also stated that a tool should be easy to use and time efficient. Cognitive interviews with stakeholders led to minor changes in the draft tool to improve usability and relevance. The final tool consisted of 4 sections: (1) eligibility for review (2 questions), (2) prioritization of review (3 questions), (3) clinical review (3 questions), and (4) economic review (5 questions).
  
  
  CONCLUSIONS
  Although the evaluation of CDTs can be challenging because of limited evidence and the added complexity of incorporating a diagnostic test into drug treatment decisions, using a pragmatic tool to identify tests that do not need extensive evaluation may improve the efficiency and effectiveness of CDT value assessments.
authors.affiliation: University of Washington, H375 HSB Box 357630, 1959 N.E. Pacific St., Seattle, WA 98195-7630. veenstra@uw.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Canestaro
authors.forename: Daryl E
authors.initials: DE
authors.lastname: Pritchard
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.forename: Robert
authors.initials: R
authors.lastname: Dubois
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019937:Diagnostic Techniques and Procedures / Q000191:economics / Q000592:standards*; D017048:Health Care Costs / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D018579:Patient Selection; D011237:Predictive Value of Tests; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000592:standards*