Nov. 12, 2007

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Is More Always Better?

Evaluating Health Care Technology

Graham Ramsay Joseph Ladapo

As physicians, hospitals, and health insurers face a rapidly expanding set of management options for treating disease, the task of sifting through scientific evidence and choosing which technological innovations to adopt and reimburse grows increasingly complex. While stakeholders struggle to find a pace of adoption that balances the needs of their clinical or business organizations, many are turning to technology research institutes to help them maximize the value of their investments. Massachusetts General Hospital’s Institute for Technology Assessment (MGH ITA) is one of the leading research centers specializing in this arena, and their work helps guide policymakers in their decision-making.

Founded only 10 years ago, the ITA is the brainchild of G. Scott Gazelle, an HMS professor of radiology. With a background in public health, health policy, and decision analysis, Gazelle and his colleagues identified early the burgeoning need for analytic methods and information synthesis in our briskly evolving health care industry. “We started the [ITA] in an effort to develop an infrastructure that would support decision science and health outcomes research,” Gazelle said. “Our goal was to create a resource for the department [of radiology], the MGH, and beyond.” Since its inception, the institute has grown significantly and is now home to 48 faculty and staff members, many of whom have been instrumental in the production of the nearly 450 publications generated by the institute over the past several years.

The ITA’s work touches upon many diverse topics across the health policy spectrum and has reviewed many interesting and controversial innovations and practices, including the risks and benefits of whole-body CT screening, the dynamics of organ allocation in transplantation, and the impact of physician self-referral on costs. Pamela McMahon, HMS instructor in radiology and a senior scientist at the ITA, is investigating the hotly debated issue of lung cancer screening in smokers. Using computer simulation methods, she and her team developed a model to assess the impact of computed tomography (CT) screening in this high-risk population.

Based on their results, McMahon concluded that “CT screening could offer a moderate reduction in lung cancer mortality and play a role in the routine health care of heavy smokers.” Her research, however, also identified an important caveat: because smokers often face high risks of death from heart disease and other morbidities, the benefits of screening are lower than they otherwise might be. “Competing mortality risks from smoking may limit the overall effectiveness of screening,” she said. Her work will help guide policymakers developing guidelines for lung cancer screening.

Chin Hur, HMS assistant professor of medicine, is a gastroenterologist and a senior scientist at the ITA. His research has focused on clinical and economic outcomes related to Barrett’s esophagus, colon cancer, and other gastrointestinal disease conditions. “As a physician investigator, my health outcomes research findings contribute directly to individual patient care,” he said. “[But] they also contribute to a larger public health policy perspective.”

This larger policy perspective is at the core of the ITA’s goals, and McMahon and Hur are two of the many researchers investigating salient topics in medical technology and the challenges—and opportunities—these innovations present for the health care community. Gazelle hopes to continue building on this goal as the ITA crosses the 10-year mark. “I think that the ITA’s future is incredibly exciting and full of possibilities,” he said.

—Joseph Ladapo is a Harvard medical student and a PhD student in health policy.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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Copyright 2007 by the President and Fellows of Harvard College