Journal article
Cross-Sectional Analysis of US Health Insurance Payer Policies for Humanitarian Device Exemption Indications for Deep Brain Stimulation
Stereotactic and functional neurosurgery, v 100(4), pp 244-247
16 May 2022
PMID: 35576905
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: The US Food and Drug Administration (FDA) has granted deep brain stimulation (DBS) approval under the humanitarian device exemption (HDE) pathway for both dystonia and obsessive-compulsive disorder (OCD). However, recent reports from the community of functional neurosurgeons suggest that insurance authorization remains a disproportionate barrier to OCD DBS implantation despite both conditions having similar support from the FDA. This cross-sectional study of health insurance policies quantifies the current payer landscape for these two interventions. Objectives: The aim of this study was to quantify the current payer policy coverage of DBS under HDE status for OCD as compared to DBS for dystonia for eligible patients in the US insurance market. Methods: A commercial health insurance policy database was queried for documentation on DBS for dystonia and OCD. Results were individually analyzed for payer policy coverage statements on DBS for either dystonia or OCD and categorized as unique or nonunique policies. Unique policy positions were then coded for the geographic region, whether coverage was offered, and guidelines cited as evidence and justification. Results: From the 80 policies in the database, there were 34 unique policies addressing DBS for either dystonia or OCD representing coverage of all 50 states. Of the 34 unique policies, 3 (9%) covered DBS for OCD, while 32 (94%) covered dystonia. Only 2 policies covered neither intervention. Conclusions: In spite of similar levels of support from the FDA, DBS for OCD has less support from insurance companies on a national level. This study begins to quantify the disparity noted by functional neurosurgeons in recent literature.
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Details
- Title
- Cross-Sectional Analysis of US Health Insurance Payer Policies for Humanitarian Device Exemption Indications for Deep Brain Stimulation
- Creators
- Dorian M. Kusyk - Allegheny Health NetworkGabriel Costa - Drexel UniversityClemens M. Schirmer - Geisinger Health SystemAlexander C. Whiting - Allegheny Health NetworkJoshua M. Rosenow - Northwestern UniversityC S Pitchumoni
- Publication Details
- Stereotactic and functional neurosurgery, v 100(4), pp 244-247
- Publisher
- Karger
- Number of pages
- 4
- Grant note
- Council of State Neurosurgical Societies Socioeconomic Fellowship
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology
- Web of Science ID
- WOS:000798162800001
- Scopus ID
- 2-s2.0-85130988850
- Other Identifier
- 991019357769404721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Neuroimaging
- Neurosciences
- Surgery