A Twitter contact recently posted accolades for SWOG and its practice of Cost Coverage Analysis. This got us wondering what this process entails in the world of cancer clinical trials. We decided to question resident expert Casey Dawson, SWOG/SWOG-CTI Project Manager.
The Hope Foundation: What is Coverage Analysis?
Casey Dawson: Coverage Analysis is a process that identifies potential costs associated with a clinical trial. On a basic level, a Coverage Analysis includes a review of the protocol* and study calendar and then a comparison with the National Comprehensive Cancer Network guidelines and the Medicare National Coverage Determination for clinical trials.
THF: How does one conduct an analysis?
CD: These tools I’ve mentioned help me outline what is considered Routine Care on a national level, and along with careful collaboration with the study team, I can determine what can be billed to patients’ insurance. Once completed and approved, the final analysis is posted to the SWOG and CTSU websites along with the funding memorandum.
THF: Why is Coverage Analysis important today?
CD: A Coverage Analysis is designed to help sites assess financial feasibility of a clinical trial and can be used as a guideline for what can and cannot be billed to patient insurance. SWOG has been touted to be the only cooperative group currently providing this information for sites. While the SWOG Coverage Analysis can be used as a guideline, we encourage sites to create their own analysis to determine if there are regional or local coverage determinations specific to their area.
THF: What’s ahead for you?
CD: I’ve been asked to present on this topic at an upcoming Clinical Billing Compliance Conference. Coverage Analysis is a key component (or should be!) in the clinical trial budgeting and billing process. I’m honored to represent SWOG at this conference, and am always happy to take any questions or comments from our participating sites.
* In a clinical trial, participants receive specific interventions according to the research plan or protocol created by the investigators.
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