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. 2021 May 1;59(5):461-466.
doi: 10.1097/MLR.0000000000001509.

Reimbursement Matters: Overcoming Barriers to Clinical Trial Accrual

Simon J Craddock Lee  1   2 , Caitlin C Murphy  1   2 , David E Gerber  1   2   3 , Ann M Geiger  4 , Ethan Halm  1   2   3 , Rasmi G Nair  1 , John V Cox  3 , Jasmin A Tiro  1   2 , Celette S Skinner  1   2
Affiliations

Reimbursement Matters: Overcoming Barriers to Clinical Trial Accrual

Simon J Craddock Lee et al. Med Care. .

Abstract

Background: Accrual to cancer clinical trials is suboptimal. Few data exist regarding whether financial reimbursement might increase accruals.

Objective: The objective of this study was to assess perceptions about reimbursement to overcome barriers to trial accrual.

Research design: This was a cross-sectional survey.

Subjects: Oncologists identified from the American Medical Association Physician Masterfile.

Measures: We report descriptive statistics, associations of physician characteristics with perceptions of reimbursement, domains, and subthemes of free-text comments.

Results: Respondents (n=1030) were mostly medical oncologists (59.4%), ages 35-54 (67%), and male (75%). Overall, 30% reported discussing trials with >25% of patients. Barriers perceived were administrative/regulatory, physician/staff time, and eligibility criteria. National Cancer Institute cooperative group participants and practice owners were more likely to endorse higher reimbursement. Respondents indicated targeted reimbursement would help improve infrastructure, but also noted potential ethical problems with reimbursement for discussion (40.7%) and accrual (85.9%). Free-text comments addressed reimbursement sources, recipients, and concerns about the real and apparent conflict of interest.

Conclusions: Though concerns about a potential conflict of interest remain paramount and must be addressed in any new system of reimbursement, oncologists believe reimbursement to enhance infrastructure could help overcome barriers to trial accrual.

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Conflict of interest statement

The authors declare no conflict of interest. Respondents (n=1030) were mostly medical oncologists (59.4%), ages 35–54 (67%), and male (75%). Overall, 30% reported discussing trials with >25% of patients. Barriers perceived were administrative/regulatory, physician/staff time, and eligibility criteria. National Cancer Institute cooperative group participants and practice owners were more likely to endorse higher reimbursement. Respondents indicated targeted reimbursement would help improve infrastructure, but also noted potential ethical problems with reimbursement for discussion (40.7%) and accrual (85.9%). Free-text comments addressed reimbursement sources, recipients, and concerns about the real and apparent conflict of interest. Though concerns about a potential conflict of interest remain paramount and must be addressed in any new system of reimbursement, oncologists believe reimbursement to enhance infrastructure could help overcome barriers to trial accrual.

Figures

Figure 1
Figure 1
shows the distribution of the levels of reimbursement (% reporting agree/strongly agree) for time spent discussing (in dark gray) and accruing (in light gray) a patient to a cancer clinical trial, relative to a new patient visit.
See this image and copyright information in PMC

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