A new report looking at health technology issues in 2012 suggests a more disciplined balance must be struck between the merits of innovative medical devices and cutting costs.
The report by the ECRI Institute in Plymouth Meeting, Pennsylvania examines the convergence of economic, patient safety, reimbursement, and regulatory pressures.
Among the technologies singled out are bariatric surgery, digital breast tomosynthesis, trans-catheter heart valve implants, personalized medicine for cancer care and proton beam radiation.
3-D digital breast tomosynthesis Mammographies were already a hot button issue. But with added innovation vs. cost considerations and it’s likely to get hotter. Adoption of full-field digital mammography since it became commercially available in 2000 has been slowed by issues like low reimbursement, high costs for acquisition and maintenance, and controversy over risks and benefits of screening and false positives. 3-D digital breast tomosynthesis requires a larger investment in exchange for more accurate results, but the clinical benefits haven’t been proven.
Ultra high field strength MRI machines On the subject of ultra high field strength MRI machines, the report says there is a strong argument for specialized programs to have this equipment such as that hospitals and practices with neurosurgery programs, but it should not be acquired for routine applications because the cost averaging $2.4 million a pop can’t be justified.
Robotic surgery advances A new, improved generation of robotic surgery devices is poised to enter the market to compete with the 1,500 daVinci robots made by Intuitive Surgical in Sunnyvale, California. Titan Medical’s version has tactile feedback technology when cutting or suturing a wound that can be give to surgeons, something the daVinci model lacks. It’s also smaller and more flexible and the Canadian company believes it will be ready for FDA approval in 2014. Although supporter argue the new generation of robots will continue to reduce surgery times and improve precision, the report is skeptical of whether the $3 million outlay is justified. “The real unanswered questions are how much value they add and, more importantly, how and when will they definitively improve patient care and long-term outcomes?
Personalized medicine for cancer care Perhaps the most interesting segment of the report is personalized cancer care treatment. It notes that many of the new biotechnologies and pharmaceuticals that come with $100,000 price tags are ad-ons, not replacements for existing therapies. “Patients are looking to hospital oncology departments to see whether these new personalized treatments are being offered. Yet, the average observed survival improvements associated with these therapies, while encouraging, are relatively modest — measured in two to six months.”
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
It warns that the personalize treatments will drive up costs. “We see increasing treatment costs of targeted therapies that require testing entire patient populations to identify the subgroups eligible for treatment. The upfront cash outlay for these individualized therapies may affect decisions to adopt when clinicians and patients weigh the evidence on potential benefits and risks.”
The debate that emerges from the pages of the report reflect a wider debate that has been shaping up in other parts of the country, including the proton beam cancer treatment center the Mayo Clinic has been developing.
