Re: Comparative Effectiveness Research

[Guest guest]

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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