Oklahoma Uses AHRQ Research to Develop, Revise Coverage Policies
As a result of participating in the Medicaid Medical Directors' Learning Network—an AHRQ Knowledge Transfer project—the Oklahoma Health Care Authority (OHCA) used an AHRQ Technology Assessment and an AHRQ Technical Brief to develop or revise coverage policies.
Paul Keenan, MD, Chief Medical Officer, and Mike Herndon, DO, Medical Director, note that OHCA staff used AHRQ's Technical Brief "Particle Beam Radiation Therapies for Cancer" in creating a guideline for the use of this therapy. Because Oklahoma houses two of the eight proton beam radiation therapy centers in the United States, OHCA needed to develop a guideline about therapy coverage and use.
The AHRQ Technical Brief notes that while there are a large number of scientific papers on charged particle radiotherapy for cancer treatment, those studies do not document the circumstances in contemporary treatment strategies in which radiotherapy with charged particles is superior to other modalities. Keenan notes that, "Informed by the AHRQ brief, OHCA developed a guideline that does not cover the therapy for adults and requires prior authorization for all requests for children."
In addition, OHCA staff learned from AHRQ's Technology Assessment "Negative Pressure Wound Therapy Devices" that all of the systematic reviews noted the lack of high-quality clinical evidence supporting the advantages of negative pressure wound therapy compared to other wound treatments. The Technology Assessment sought to determine whether any single negative pressure wound therapy system had any therapeutic distinction over another negative pressure wound therapy system in treating acute or chronic wounds. The authors found no studies that make direct comparisons of one system to another.
Before reading the AHRQ assessment on negative pressure wound therapy, OHCA covered the devices at great expense to the State. In 2007, 171 patients were treated at a cost of $376,117. Then OHCA revised its policy to support prior authorization to help ensure appropriate use of the therapy. Consequently, in 2009, just 89 patients were treated at a cost of $153,194. Herndon says, "After instituting prior authorization, utilization decreased, and there was a cost savings for appropriate care."
Trikalinos TA, Terasawa T, Ip S, et al. Particle Beam Radiation Therapies for Cancer. Technical Brief No. 1. (Prepared by Tufts Medical Center Evidence-based Practice Center under Contract No. HHSA-290-07-10055.) Rockville, MD: Agency for Healthcare Research and Quality; November 2009.
Sullivan N, Snyder D, Tipton J, et al. Negative Pressure Wound Therapy Devices. Technology Assessment Report. (Prepared by ECRI Evidence-based Practice Center under Contract No. 290-2007-10063.) Rockville, MD: Agency for Healthcare Research and Quality; May 2009.