Shearwood McClelland1, Vivek Verma2. 1. Department of Radiation Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT 041, Indianapolis, IN 46202, US. 2. Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, US.
Abstract
OBJECTIVES: The coverage policies of many commercial insurers in the United States do not include coverage of stereotactic radiosurgery (SRS) for intractable epilepsy despite recent Level I evidence supporting its efficacy. We sought to assess the efficacy of an evidence-based methodology in obtaining coverage approval of SRS for intractable epilepsy. PATIENTS AND METHODS: The clinical policy guidelines from five of the largest United States commercial insurers were reviewed for their language regarding coverage of SRS for epilepsy. An evidence-based questionnaire was created for temporal lobe epilepsy and extratemporal lobe epilepsy based on recent evidence. Telephone interviewers of Insurers assessed the likelihood of SRS coverage for an epilepsy patient meeting the clinical inclusion criteria in the questionnaire. This likelihood was assessed numerically based on interviewee response (2 = yes, 1 = dependent on peer-to-peer, 0 = no). RESULTS: Of the five policy guidelines, none included literature more recent than 2017. For TLE, 3/5 insurance companies indicated likely SRS coverage; 2/5 indicated peer-to-peer discussion dependence for patients meeting questionnaire criteria for a score of 8/10. For extratemporal TLE, 2/5 companies indicated likely SRS coverage and 3/5 indicated peer-to-peer discussion dependence for a total score of 7/10. CONCLUSION: Creation of an evidence-based methodology in approaching commercial insurers greatly increased the likelihood of SRS coverage for an indication (intractable epilepsy) widely perceived as investigational. These results should pave the way for epilepsy patients to receive coverage should they be appropriate SRS candidates.
OBJECTIVES: The coverage policies of many commercial insurers in the United States do not include coverage of stereotactic radiosurgery (SRS) for intractable epilepsy despite recent Level I evidence supporting its efficacy. We sought to assess the efficacy of an evidence-based methodology in obtaining coverage approval of SRS for intractable epilepsy. PATIENTS AND METHODS: The clinical policy guidelines from five of the largest United States commercial insurers were reviewed for their language regarding coverage of SRS for epilepsy. An evidence-based questionnaire was created for temporal lobe epilepsy and extratemporal lobe epilepsy based on recent evidence. Telephone interviewers of Insurers assessed the likelihood of SRS coverage for an epilepsy patient meeting the clinical inclusion criteria in the questionnaire. This likelihood was assessed numerically based on interviewee response (2 = yes, 1 = dependent on peer-to-peer, 0 = no). RESULTS: Of the five policy guidelines, none included literature more recent than 2017. For TLE, 3/5 insurance companies indicated likely SRS coverage; 2/5 indicated peer-to-peer discussion dependence for patients meeting questionnaire criteria for a score of 8/10. For extratemporal TLE, 2/5 companies indicated likely SRS coverage and 3/5 indicated peer-to-peer discussion dependence for a total score of 7/10. CONCLUSION: Creation of an evidence-based methodology in approaching commercial insurers greatly increased the likelihood of SRS coverage for an indication (intractable epilepsy) widely perceived as investigational. These results should pave the way for epilepsy patients to receive coverage should they be appropriate SRS candidates.
Authors: Vivek Verma; Ethan B Ludmir; Shane M Mesko; Eric D Brooks; Alexander Augustyn; Michael T Milano; Steven H Lin; Joe Y Chang; James W Welsh Journal: Pract Radiat Oncol Date: 2019-08-22
Authors: Marian Galovic; Irene Baudracco; Evan Wright-Goff; Galo Pillajo; Parashkev Nachev; Britta Wandschneider; Friedrich Woermann; Pamela Thompson; Sallie Baxendale; Andrew W McEvoy; Mark Nowell; Matteo Mancini; Sjoerd B Vos; Gavin P Winston; Rachel Sparks; Ferran Prados; Anna Miserocchi; Jane de Tisi; Louis André Van Graan; Roman Rodionov; Chengyuan Wu; Mahdi Alizadeh; Lauren Kozlowski; Ashwini D Sharan; Lohith G Kini; Kathryn A Davis; Brian Litt; Sebastien Ourselin; Solomon L Moshé; Josemir W A Sander; Wolfgang Löscher; John S Duncan; Matthias J Koepp Journal: JAMA Neurol Date: 2019-06-01 Impact factor: 18.302
Authors: Nicholas M Barbaro; Mark Quigg; Mariann M Ward; Edward F Chang; Donna K Broshek; John T Langfitt; Guofen Yan; Kenneth D Laxer; Andrew J Cole; Penny K Sneed; Christopher P Hess; Wei Yu; Manjari Tripathi; Christianne N Heck; John W Miller; Paul A Garcia; Andrew McEvoy; Nathan B Fountain; Vincenta Salanova; Robert C Knowlton; Anto Bagić; Thomas Henry; Siddharth Kapoor; Guy McKhann; Adriana E Palade; Markus Reuber; Evelyn Tecoma Journal: Epilepsia Date: 2018-03-30 Impact factor: 5.864
Authors: H Kurita; S Kawamoto; I Suzuki; T Sasaki; M Tago; A Terahara; T Kirino Journal: J Neurol Neurosurg Psychiatry Date: 1998-11 Impact factor: 10.154