Questions for the Panelists—Workshop 1November 7, 2006

Panel 1—PET Scans for Alzheimer’s

  • What does this experience show about the feasibility of coverage with evidence development under Medicare?

  • What roles did evidence assessment and political pressure have in this coverage decision? How is this experience instructive for future cases?

  • What challenges were involved in ensuring that the evidence available on PET was applicable to everyday clinical practice?

Panel 2—Lucentis/Avastin

  • Was the substantial uptake in Avastin use for wet AMD justifiable given the lack of evidence and the needs of the patient population?

  • How do evidence reviewers and payers address the relative effectiveness of Lucentis and Avastin given the limited data?

  • Given the state of the evidence base, what role should cost play in payer decisions?

  • What does this case study say about the societal need for more clinical data and information and the mechanisms by which data development is financed?

  • How will the head-to-head trial supported by NIH alter their role in terms of assessing cost effectiveness?

Panel 3—Genetic Tests

  • Do you think that more of these types of tests will be developed [toxicity, and non-invasive screening]? How will experiences with these technologies affect the development of more similar tests?

  • Are non-invasive screenings (genetic byproduct screening) and toxicity testing the “wave(s) of the future”? What types or levels of evidence are needed to recommend replacement of current therapies? Will comparative testing be done as newer technologies emerge?

  • Are there specific challenges due to the nature of the populations qualified for testing? (Such as, are the populations so small as to affect the feasibility of large clinical trials?)

  • As the evidence for these tests is emerging, how do gaps in evidence compare with more traditional technologies?

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