Putting a Price on Medical Miracles

Originally Published May 2000

EDITOR'S PAGE

Putting a Price on Medical Miracles

What if you build it and they don't come? Even under the best of circumstances, you're going to agonize over whether or not a device or novel technology will find acceptance in the marketplace. The last thing you need is one more obstacle. Unfortunately, the vogue for healthcare technology assessments (HTAs) in various parts of the world has the potential to become just that.

The practice is not new—it emerged with the advent of the computed tomography scanner in the 1970s as a means to evaluate the clinical and cost effectiveness of new medical equipment. While this remains the stated objective of HTAs, the research is increasingly being used by purchasers of medical equipment and governments for more-questionable motives. In some cases, HTA results have been used to block access to national markets. It's not surprising then that the topic has received considerable attention at recent conferences devoted to device industry issues.

A cautionary note was struck at the Global Device Conference in Cancún, Mexico, in January. Ed Rozynski, executive vice president of HIMA, urged industry to initiate a global dialogue on HTAs. Various technology assessment schemes have been implemented or are under construction in several member states of the European Union and Japan, he noted, and the existence of divergent national approaches could represent a significant burden for device companies.

Ann-Marie McIntyre, senior manager at the Lewin Group consultancy, a division of Quintiles, took a different tack at the annual meeting of the Association of British Health-Care Industry in London in March. Her primer on HTAs sought to take some of the edge off the debate by clearly defining the objectives and explaining the methodologies.

"In order to make the best use of scarce healthcare resources," McIntyre told attendees, "the diffusion and adoption of new technologies should be linked to evidence of their clinical and cost effectiveness. HTA is therefore the evaluation of a medical technology for evidence of safety, efficacy, cost, and cost effectiveness . . . both in absolute terms and in comparison with other competing technologies." While the concept is fairly transparent, the process of conducting an appropriate assessment is not as clear-cut.

McIntyre argued, for instance, that the important and relevant direct and indirect benefits and costs should be identified when measuring the value of a new technology. Quality of life issues, for example, may be difficult to quantify in some cases, but they should certainly be factored into the equation. In addition, she noted, different procedures may have different time profiles of costs. "The costs of hypertension screening would be incurred in the present, whereas the benefits may not be seen for some years," she explained. The knife cuts both ways, however. Are annual prostate cancer screenings among asymptomatic men necessarily a good idea? Perhaps not, said McIntyre, because screenings may detect microscopic cancers that are less detrimental to the patient than the subsequent treatment employed to eradicate the cancerous cells.

The aim of HTAs is "to promote a more rational use of healthcare services, not to save money by denying services," stressed McIntyre. In an ideal world, I think we would all agree with that objective. Unfortunately, HTAs do not exist in a vacuum. In an environment where cost containment is a fact of life, it would be naive to think that they will not be used as ballast by flighty purchasers and legislators to justify dubious healthcare budgeting decisions.

HTAs are not going away. The best option for industry, at this juncture, is to remain vigilant that budgets are not balanced at the expense of legitimate advances in patient care.

Norbert Sparrow
[email protected]

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