Managed Care - November 2008 - (Page 28)

broadly considered worthwhile. It isn’t clear exactly how and when biomarkers will claim a similar role. Rodgers points out that the National Cancer Institute has established the Early Detection Research Network (EDRN) to focus on biomarkers and other methods to detect cancer. Biomarkers can help, he says, in two ways: • Multiple markers can be viewed in combination. This process, called “stacking,” can be more revealing than checking one marker in isolation. The “velocity of change” in biomarkers can be tracked over time. Such investigation of “stacked” markers can be more revealing than the same group examined at just one or two comparison points. • there are hundreds of possible tests. There are a few serum-marker tests that probably should be covered today, but it’s very difficult to sort those out.” Will serum biomarkers be part of a new “personalized” approach to organizing the care of populations by health plans? Science suggests that in some form they probably will, even if today’s plans are only beginning to figure out how. Someday, perhaps, ignoring a hundred tales the blood can tell will seem as unthinkable as neglecting a growth that keeps on growing. MC Did you miss? David Eddy, MD Blaine J. Bos Barbara Starfield, MD Reed Tuckson, MD Bruce Bagley, MD Emad Rizk, MD James Schibanoff, MD William Winkenwerder, MD Newt Gingrich Howard Dean David M. Lawrence, MD Paul Ellwood, MD Paul Ginsburg, PhD Alain Enthoven, PhD We don’t run our Question and Answer feature every month. That’s because we don’t talk to just anybody. Today’s researchers are refining these techniques to discover cancer at its earliest stages. And they are making inroads with ovarian cancer, the fourth most common cause of cancer deaths among women, which is generally symptom-free until its very late stages, yet has a high cure rate when diagnosed early. Biomarkers such as CA-125, CA 15-3, CA 19-9, interleukin-6, interleukin-8, monocyte chemotactic protein-1 (MCP-1), epithelial growth factor (EGF), and vascular endothelial growth factor (VEGF) are among those considered promising in screening for early ovarian cancer, says Rodgers. But today, says Lee Newcomer, MD, executive vice president for oncology services at United HealthCare, cancer treatment gets a more potent assist from markers in malignant tissue itself than from those in the blood. For example, a positive test for human epidermal growth factor receptor-2 (HER-2) now reveals whether a breast-cancer patient will respond to the new drug Herceptin, with dramatic results. “When you’re talking about screening lots of normal people,” warns Newcomer, “you need a test that’s very, very specific.” He points out another practical obstacle. “The big problem for health plans today is the way these blood tests are coded and billed for, which isn’t keeping pace with technology,” he says. “We don’t know whether a given test is for ovarian cancer, diabetes, asthma, or heart failure, because the code only describes the process, and under that process Read these interviews at www.managedcaremag.com Care M A N A G E D Just search for the subject’s last name. All of our past articles are free on the Web. 28 MANAGED CARE / NOVEMBER 2008 http://www.managedcaremag.com http://www.managedcaremag.com

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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