title: Health Technology Assessment for Molecular Diagnostics: Practices, Challenges, and Recommendations from the Medical Devices and Diagnostics Special Interest Group.
abstract: Health technology assessments (HTAs) are increasingly used to inform coverage, access, and utilization of medical technologies including molecular diagnostics (MDx). Although MDx are used to screen patients and inform disease management and treatment decisions, there is no uniform approach to their evaluation by HTA organizations.
  
  
  
  The International Society for Pharmacoeconomics and Outcomes Research Devices and Diagnostics Special Interest Group reviewed diagnostic-specific HTA programs and identified elements representing common and best practices.
  
  
  
  MDx-specific HTA programs in Europe, Australia, and North America were characterized by methodology, evaluation framework, and impact. Published MDx HTAs were reviewed, and five representative case studies of test evaluations were developed: United Kingdom (National Institute for Health and Care Excellence's Diagnostics Assessment Programme, epidermal growth factor receptor tyrosine kinase mutation), United States (Palmetto's Molecular Diagnostic Services Program, OncotypeDx prostate cancer test), Germany (Institute for Quality and Efficiency in Healthcare, human papillomavirus testing), Australia (Medical Services Advisory Committee, anaplastic lymphoma kinase testing for non-small cell lung cancer), and Canada (Canadian Agency for Drugs and Technologies in Health, Rapid Response: Non-invasive Prenatal Testing).
  
  
  
  Overall, the few HTA programs that have MDx-specific methods do not provide clear parameters of acceptability related to clinical and analytic performance, clinical utility, and economic impact. The case studies highlight similarities and differences in evaluation approaches across HTAs in the performance metrics used (analytic and clinical validity, clinical utility), evidence requirements, and how value is measured. Not all HTAs are directly linked to reimbursement outcomes.
  
  
  
  To improve MDx HTAs, organizations should provide greater transparency, better communication and collaboration between industry and HTA stakeholders, clearer links between HTA and funding decisions, explicit recognition of and rationale for differential approaches to laboratory-developed versus regulatory-approved test, and clear evidence requirements.
authors: EY Boston, Boston, MA, USA. Electronic address: susansgarfield@gmail.com.
authors: Susan
authors: S
authors: Garfield
authors: Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
authors: Julie
authors: J
authors: Polisena
authors: Courtagen Life Sciences, Inc., Woburn, MA, USA.
authors: Daryl
authors: D
authors: S Spinner
authors: Medical and Economic Value, Cepheid Europe, Maurens-Scopont, France.
authors: Anne
authors: A
authors: Postulka
authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
authors: Christine
authors: C
authors: Y Lu
authors: Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Alberta, Canada; Evidera, Bethesda, MD, USA.
authors: Simrandeep K
authors: SK
authors: Tiwana
authors: Evidera, Bethesda, MD, USA; Center for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA; Genomics, Biotech and Emerging Technology Institute, NAMCP, Glen Allen, VA, USA.
authors: Eric
authors: E
authors: Faulkner
authors: Roche Molecular Systems, Inc., Pleasanton, CA, USA.
authors: Nick
authors: N
authors: Poulios
authors: ISPOR Serbia, Belgrade, Serbia.
authors: Vladimir
authors: V
authors: Zah
authors: Danaher Corporation, Diagnostic Platform, Washington, DC, USA.
authors: Michael
authors: M
authors: Longacre
mesh_terms: D038622:Internationality; D057089:Pathology, Molecular; D058996:Quality Improvement; D013673:Technology Assessment, Biomedical / Q000379:methods* / Q000592:standards*
keywords: diagnostics; health technology assessment