Re: Comparative Effectiveness Research

November 22, 2008

The problem I have with the example presented is that the only criteria given for 'cost effectiveness" was that 3D conformal radiation had a higher risk of procritis than IMRT. Nothing was said about the relative effectiveness on treating prostate cancer. And, other potential effects of the larger 3D conformal radiation field were not mentioned. Like so many aspects of our disease, the results of a 'cost effectiveness' analysis depends so much on the assumptions and parameters of the study.

With respect to insurance companies and Medicare limiting payments, seems to me that an effective alternative would be to not deny payment for new more expensive treatments such as Cyberknife because there is insufficient data on relative effectiveness but rather limit payment to the level of payment for 'approved' treatments. That way there would be equal cash subsidy for the new treatments to encourage those who can afford the difference to pursue the new treatments, thereby building up case histories for evaluation of effectiveness. It also would be an incentive for the purveyers of the new technologies to try and reduce costs. The way it is now is 'all or nothing'.

The Best to You and Yours!

Jon in Nevada

In a message dated 11/22/2008 1:15:19 AM Pacific Standard Time, ProstateCancerSupport writes:

Posted by: "Kathy Meade" mailto:kmeadelist@...?Subject= Re%3AComparative%20Effectiveness%20Research%20from%20a%20blog merrywidow225

Fri Nov 21, 2008 4:23 am (PST)

You should be aware of discussions like this that are going on now. If youhave a problem with this type of discussion with the potential outcome oflimiting payment for treatments then patients need to get involved nowbefore changes happen. Patients need to be at meetings like this to speakabout the value of QOL. Now is the time to get involved before coverage'sare limited.Kathy*******************Steve does do cost-benefit analysis, and used as one of his examples a studyhis group did on the cost-effectiveness of IMRT (Intensity ModulatedRadiation Therapy - new way) vs. 3D-CRT (3-dimensional conformal radiationtherapy - old way) for treating prostate cancer. The old way does lead, onoccasion, to proctitis (bowel inflammation) in some patients, while the newway can reduce the likelihood of this side effect. Proctitis isuncomfortable, but pretty treatable, and certainly not life threatening.

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November 23, 2008

Debbie,

NO! It is NOT a " shot in the dark! "

Treatments, including surgery, are improving with increased

experience, techniques, and new drugs; and even combinations of

different therapies.

The trick is to find the most experienced and knowledgable specialist

in prostate cancer. And one that " stays on top " of new developments.

Having said all that, please do not neglect to look into proton beam

radiation therapy if you are truly interested in a treatment that is

as effective as any other with usually far less side effects, and

when there are side effects, they are minimal.

To find out more, join our group at:

http://health.groups.yahoo.com/group/protoninfo/

Fuller

>

> Subject: RE: Re: Comparative Effectiveness

Research

> To: ProstateCancerSupport

> Date: Saturday, November 22, 2008, 9:33 PM

>

> Jon,

>

> I certainly think your idea has merit, but the big drawback would

be in dealing with the side effects that often accompany new

treatments until they are tested and, perhaps, modified. I have read

some of the early studies on HIFU in Europe and it is clear that in

the early days the levels of urinary problems was very high indeed.

It seems these were associated with the sloughing of material from

the bladder following collateral damage caused by overheating, or

perhaps over-shooting the intended treatment area. Insurers would

presumably have to pick up costs associated with such side effects on

the basis that they would meet the costs of similar side effects

from, say, radiation therapy.

>

> No doubt a way could be found around such issues to encourage the

safe development of new treatments, but there would certainly be

risks and costs involved that would be difficult for an insurer to

assess without adequate data.

>

> All the best

>

> Terry Herbert

> I have no medical qualifications but I was diagnosed in `96: and

have learned a bit since then.

> My sites are at www.yananow. net and www.prostatecancerw

atchfulwaiting. co.za

> Dr " Snuffy " Myers : " As a physician, I am painfully aware

that most of the decisions we make with regard to prostate cancer are

made with inadequate data "

>

> From: ProstateCancerSuppo rtyahoogroups (DOT) com [mailto:ProstateCan

cerSupport@ yahoogroups. com] On Behalf Of ccnvw@...

> Sent: Sunday, 23 November 2008 3:06 AM

> To: ProstateCancerSuppo rtyahoogroups (DOT) com

> Subject: [ProstateCancerSupp ort] Re: Comparative Effectiveness

Research

>

> The problem I have with the example presented is that the only

criteria given for 'cost effectiveness " was that 3D conformal

radiation had a higher risk of procritis than IMRT. Nothing was said

about the relative effectiveness on treating prostate cancer. And,

other potential effects of the larger 3D conformal radiation field

were not mentioned. Like so many aspects of our disease, the

results of a 'cost effectiveness' analysis depends so much on the

assumptions and parameters of the study.

>

> With respect to insurance companies and Medicare limiting payments,

seems to me that an effective alternative would be to not deny

payment for new more expensive treatments such as Cyberknife because

there is insufficient data on relative effectiveness but rather limit

payment to the level of payment for 'approved' treatments. That way

there would be equal cash subsidy for the new treatments to encourage

those who can afford the difference to pursue the new treatments,

thereby building up case histories for evaluation of effectiveness.

It also would be an incentive for the purveyers of the new

technologies to try and reduce costs. The way it is now is 'all or

nothing'.

>

> The Best to You and Yours!

>

> Jon in Nevada

>

> In a message dated 11/22/2008 1:15:19 AM Pacific Standard Time,

ProstateCancerSuppo rtyahoogroups (DOT) com writes:

>

> Posted by: " Kathy Meade " mailto:kmeadelist@ aec225.com? Subject= Re%

3AComparative% 20Effectiveness% 20Research% 20from%20a% 20blog

merrywidow225

> Fri Nov 21, 2008 4:23 am (PST)

>

> 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

>

> ************ *******

>

> 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.

>

> Check out smokin' hot deals on laptops, desktops and more from

Dell. Shop Deals

>

November 23, 2008