Role of Cochrane Reviews in informing US private payers’ policies

AIM: To assess the use of Cochrane Reviews to inform the medical policy documents of major US private payers. METHODS: The publically available drug policy documents of the five major US private payers (covering about 50% market) namely: Anthem, Aetna, Cigna, Humana and United Healthcare (UHC) were assessed in February 2017 and reviewed to find whether they had used Cochrane Reviews. We extracted information such as use of Cochrane Reviews, number of Cochrane Reviews used, context of use and impact of Cochrane Reviews on policy, and Cochrane Review Group (CRG) and Cochrane Center linked to the Cochrane Review. RESULT: Among the selected payers, less than half of the policy documents used Cochrane Reviews: maximum for Aetna (52%) and minimum for Humana (2%). Three hundred and sixty-one Cochrane Reviews from 42 CRGs have been used to inform 118 drug policy documents: Aetna (221) Anthem (64), Cigna (30), and UHC (25). The highest number of reviews used from any Cochrane Center was 79 (UK). The most reviews used from any CRG were 27 (Musculoskeletal Group). The most reviews used to inform any one policy was 18 (Drug: Botulinum Toxin, Payer: Aetna). Overall, 66% of the Cochrane Reviews were used to inform the background section of the policy document and 34% supported the clinical usage of the drug. Furthermore, 42% of the reviews had cited inline in the policies they were used to inform. CONCLUSION: Cochrane Reviews are used to inform the US healthcare payers' policies, but there is still scope to encourage the further usage of Cochrane Reviews in healthcare decision making.