May 21, 2007
Student Scene
New Yardstick Measures Value of Health Care Technologies
Graham
Ramsay
Joseph Ladapo |
The brisk pace of technological advancement in health care has introduced seemingly endless new care options for patients, but has also complicated the medical decision-making process for physicians and policymakers. Concerned with clinical effectiveness, cost-effectiveness, safety, and patient preferences, physicians must choose from a growing array of treatment alternatives, while insurers struggle to decide which interventions to cover and how generously to cover them. As technological evolution marches on, health care groups will need organizations that can translate scientific and economic evidence into a format that facilitates decision-making. The recently established Institute for Clinical and Economic Review, or ICER, aims to do just that.
Founded by Dr. Steven Pearson, HMS associate clinical professor of ambulatory care and prevention, ICER is a burgeoning initiative based in the Department of Ambulatory Care and Prevention at HMS and Harvard Pilgrim Health Care. Focused on synthesizing information on both the clinical effectiveness and comparative economic value of medical innovations, ICER aims to transform the way in which clinicians and policymakers conceptualize the application of new technologies. According to Pearson, historically, “technology assessments in the United States have looked only at clinical effectiveness and have not assessed the broader implications of a technology for the health care system.” The ICER framework for appraising innovations integrates both features and allows decision-makers to consider both the marginal clinical value and marginal cost of a new technology.
By focusing on both the clinical effectiveness and comparative value of new technologies … ICER promises to offer a perspective that has been largely absent from the U.S. health care scene. |
The organization was partially inspired by the National Institute for Health and Clinical Excellence (NICE), which appraises technologies for the United Kingdom’s publicly funded health care system. Though the institute has faced criticism for not recommending coverage for some innovations, it has succeeded in establishing a transparent process by which technologies can be assessed with the input of major stakeholders. Dr. Gillian Leng, a member of its board of directors, said, “Taking both clinical and economic perspectives into account is a core component” of NICE’s approach to making coverage decisions. He also believes that the U.S. health care system would likely benefit from a similar decision-making system.
Pearson and his team of co-investigators are currently appraising a relatively new technology for the treatment of localized prostate cancer called intensity-modulated radiation therapy, or IMRT. Compared to the conventional radiotherapy treatment given to prostate cancer patients, IMRT is significantly more expensive, but it may lower the rate of gastrointestinal side effects, which are commonly experienced in this patient population. Moreover, these side effects are associated with lower patient-reported quality of life, and researchers are increasingly finding evidence that IMRT may also be more effective at preventing relapse. IMRT is a classic example of a medical technology whose adoption involves multiple tradeoffs between clinical effectiveness, cost, safety, and patient preferences.
ICER’s debut on the playing field of medical decision-making and technological innovation could not be more timely. By focusing on both the clinical effectiveness and comparative value of new technologies, and by synthesizing these characteristics in a rigorous and digestible manner, ICER promises to offer a perspective that has been largely absent from the U.S. health care scene. Indeed, the institution’s value will grow as quickly as the technological innovations it aims to assess.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.
Copyright 2007 by the President and Fellows of Harvard College