PAP TESTS: Insurers Wary Of Covering Cytyc Corp. Test
A front-page story in today's Wall Street Journal profiles the difficulty Cytyc Corp. is having in getting insurers to cover its ThinPrep Pap test, a new "high-tech" process that can detect precancerous cervical lesions at an earlier stage than the standard test. ThinPrep has been deemed "significantly more effective" than the standard test by the Food and Drug Administration, but "[o]nly about 12% of the nation's insurers are willing to pay ... for the test," according to Cytyc CEO Patrick Sullivan. As a result, only about 5% of the Pap smears currently being done in the U.S. use the technology. The major barrier to gaining insurers' support, the Journal notes, is ThinPrep's cost -- "$15 to $20 more than the standard test." According to one insurance company-funded analysis, prepared by Stanford University economist Alan Garber, "annual use of ThinPrep would cost more than $300,000 -- borne mostly by insurers -- for every year it prolongs a woman's life, compared with $27,000 per year saved with a conventional Pap test." Garber said, "We have many incremental technologies coming along that give small benefits and are very expensive. It's not going to be feasible in the long term to say 'yes' to everything that may be better and ignore the costs." The Journal notes that the American College of Obstetricians and Gynecologists has "declined to recommend [ThinPrep] as a standard of care, citing high costs and noting that clinical trials haven't proven that the earlier detection actually saves lives." And some insurers are disputing the clinical tests that show better results for ThinPrep, arguing that the results were not based on sufficiently large samples.
Light At The End Of The Tunnel?
Cytyc has had some success in persuading insurers to cover ThinPrep. A company-sponsored analysis, conducted by Quintiles Transnational Corp., "concluded that ThinPrep will save money by detecting abnormalities earlier and by reducing the number of unreadable tests." President Clinton ordered Medicare to begin covering the test starting next year, and Cigna Corp. has approved coverage. Last December, Harvard Pilgrim Health Care opted to cover ThinPrep as well. "This is a women's health issue -- potentially inflammatory -- and we pride ourselves on our reputation for women's health care." All major insurers in Connecticut now cover ThinPrep, partly as a response to "an influential group of female gynecologists, Women's Health Connecticut," which last fall "sent out a letter asking insurers to cover the new test." Cytyc's Sullivan said, "We're seeing a light at the end of the tunnel."
The Journal notes that one of the nation's largest insurers, Aetna U.S. Healthcare, still refuses to cover ThinPrep. Dr. Arnold Cohen, the insurer's medical director for women's health, said, "There are 50 million Pap smears done a year. So we're talking about a billion additional dollars for a technology that has yet to be proven to improve people's lives." Another analysis of ThinPrep, sponsored by the Blue Cross and Blue Shield Association's Technology Evaluation Center and written by Stanford University's Dr. Garber, "determined that ThinPrep would add only about five hours to the average woman's life if used every year instead of the traditional Pap." Cytyc disputes the study and has hired additional sales staff to tout ThinPrep to insurers. Cytyc has also "convinced a Pennsylvania state representative to file a bill that would require insurers in the state to cover" the test (Johannes, Wall Street Journal, 8/13).