Adoption of new technology needs to be evidence-based to reduce health
care costs
11 January 2007 Advances in medical technology are a main factor
driving the trend of increasing health care costs. Including evidence-based
decision-making in the healthcare coverage process would ensure that use of
new therapy and technology is tied to evidence of clinical benefit These
are the conclusions of a new study by Rita Redberg, MD, MSc, Director of
Women’s Cardiovascular Services at the University of California San
Francisco (UCSF) Medical Center and professor of clinical medicine in the
UCSF School of Medicine. Her analysis appears in the January/February 2007
edition of the health policy journal Health Affairs, which devotes
the full issue to cardiovascular medicine.
“Any new technology is only valuable to the extent that it leads to improved
patient care,” says Redberg. “The current ‘pay now, benefits might follow’
model is in part to blame for why the U.S. spends more per capita on health
care than any other nation yet its system ranks only 37th in performance.”
Current estimates show health care spending in the United States exceeds 15%
of the gross domestic product. According to the National Coalition on Health
Care, this spending — more than three times the rate of inflation —is
expected to increase to more than 20 percent of the GDP in the next decade.
In the paper, Redberg shows how current health care technology policy and
adoption processes enable high costs to occur. She proposes an
evidence-based process that would produce a more unified medical policy that
is better equipped to grapple with tensions among quality, innovation and
value than the current U.S. system. To date, the U.S. has no nationally
coordinated policy on technology assessment and lacks a widespread clinical
electronic medical record database — which hinders data gathering for
technology assessment.
A wide range of participants in the health care industry — from medical
institutions and insurance companies to Medicare and other administrative
agencies — agree on the need for a new review system, she says.
“Using study data that shows which patients will have a net benefit from a
drug or procedure is called evidence-based technology assessment. Its
importance is becoming increasingly recognized,” Redberg says. “However,
evidence-based review of new technology is not always translated into health
policy.”
She argues that as the volume, complexity and cost of new medical technology
increases, the need for evaluating benefits and risks becomes increasingly
important. “Unfortunately, few systematic criteria are currently applied to
ensure patient benefit after formal requirements for Food and Drug
Administration approval and insurance coverage are met,” she says.
Using cardiac computed tomography angiography as a case study, Redberg says
a more systematic policy approach to evaluate the efficacy of new
technologies would also help determine patient benefit and ensure that the
benefits justify the cost. She explains that CTA is a particularly useful
example for technology assessment because it is undergoing rapid, widespread
adoption due to advances in imaging, a rise in entrepreneurial activity by
physicians and increased patient demand due to media attention and
direct-to-consumer advertising. This adoption is occurring despite little
evidence showing CTA leads to better patient care than alternative
procedures.
According to Redberg, in order to evolve toward a more systematic approach
and increase value, there first must be an acknowledgement of the importance
of evidence-based health policy, and second, an evidence-based approach that
includes re-evaluation over time must be incorporated into approval and
coverage decisions.
“Including evidence-based decision-making in the healthcare coverage process
would ensure that use of new therapy and technology is tied to evidence of
clinical benefit, resulting in a value-based health care system,” Redberg
says. To top
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