Comparative Effectiveness Research from a blog

[Guest guest]

You should be aware of discussions like this that are going on now. If you have a problem with this type of discussion with the potential outcome of limiting payment for treatments then patients need to get involved now before changes happen. Patients need to be at meetings like this to speak about the value of QOL. Now is the time to get involved before coverage's are limited.

Kathy

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Steve does do cost-benefit analysis, and used as one of his examples a study his group did on the cost-effectiveness of IMRT (Intensity Modulated Radiation Therapy — new way) vs. 3D-CRT (3-dimensional conformal radiation therapy — old way) for treating prostate cancer. The old way does lead, on occasion, to proctitis (bowel inflammation) in some patients, while the new way can reduce the likelihood of this side effect. Proctitis is uncomfortable, but pretty treatable, and certainly not life threatening.

That makes it clinically more effective — but does it make it more cost-effective?

As is often the case, Medicare likes the “new way” better than the “old way” and pays $42,000 a pop for IMRT, but only $10,000 for 3D-CRT. Not to rag on Medicare — but does this seem surprising to anyone? Anyway, guess which way we treat prostate cancer in the U.S.? The Health Care Quality and Cost Council in Massachusetts says IMRT finishes 9th on its list of the most used/expensive outpatient procedures in Massachusetts.

Steve’s group took a pretty deep look at whether the additional cost of IMRT was worth the benefit of reducing some proctitis cases in some patients. They concluded that the cost to Medicare of preventing one case of proctitis was $300,000. I would note here that this number would work for almost of us in health care, too — since we usually use Medicare fee schedules as our baseline for payment as well.

So from Steve’s point of view, it would be very, very hard to argue that this new way is cost effective, relative to the old way — given the very high cost of preventing a treatable, manageable side effect of prostate cancer treatment. But we use it. A lot.

We need more analysis like this about health care in this country. Our system is more technologically sophisticated than it’s ever been before, our costs are higher than they’ve ever been before, and other countries are leading the charge in this area, while we watch. This makes no sense to me at all. I would much rather spend more money on things that make sense and are cost-effective, and less on things that aren’t than the other way around. Right now, we seemed destined to do the latt

http://www.letstalkhealthcare.org/medicare/comparative-effectiveness-research/