Abstract
Innovative technology has the potential to improve patient outcomes, but also to substantially increase healthcare cost. Understanding how to evaluate the value of new technology requires an appreciation of the underlying economics and a measure of patient outcomes. If the economic consequences of applying a technology do not measurably improve patient outcomes, then there is an uncoupling of the two. A review of a highly innovative medical technology, the surgical robot, evaluating funding, marketing, use and measures of outcomes and effectiveness. The rational for funding the development and initial implementation of innovative technology is complex. The consumers of medical technologies (physician and patient) are unique in that they are not normally directly impacted by the cost. The purchaser, the hospital, must therefore shift the expense to other sources of revenue. The incentive to use innovative medical technology may not be consistently tied to outcomes. There is a lack of clarity regarding who is in the best position to determine the value of innovative technology in healthcare. Comparative effectiveness research that is transparent and objectively considers the implications of using new technology is needed, not just at the individual level, but also at the system and societal level.
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References
Technological Change and the Growth of Health Care Spending. Congress of the United States, Congressional Budget Office. 2008. https://www.cbo.gov/sites/default/files/110th-congress-2007-2008/reports/01-31-techhealth.pdf
White GR, Graham MBW. How to spot a technological winner. Harv Bus Rev. 1978;56:146–52.
Ballantyne GH. Robotic surgery, telerobotic surgery, telepresence, and telementoring. Surg Endosc. 2002;16(10):1389–402.
Gerin R. SRI to develop robotics for battlefield care. Washington Post. 2005. page E04. Available at http://www.washingtonpost.com/wp-dyn/articles/A23899-2005Apr3.html.
Gourin CG, Terris DJ. Surgical robots in otolaryngology: expanding the technology envelope. Curr Opin Otolaryngol Head Neck Surg. 2004;12(3):204–8.
Andrews M. Questions arise about robotic surgery’s cost, effectiveness. Kaiser Health News. 2013.
Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, et al. Robotically assisted vs. laparoscopic hysterectomy among women with benign gynecologic disease. JAMA. 2013;309(7):689–98.
Barbash G, Glied Sherry A. New technology and health care costs–the case of robot-assisted surgery. NEJM. 2010;363(8):701–4.
Greenberg Herb. Marketing is key to surgical robot’s success. CNBC. 2013. www.cnbc.com/id/100652922
Langreth R. Robot surgery damaging patients rises with marketing. Bloomberg online. 2013. p. 1–10. https://www.bloomberg.com/news/articles/2013-10-08/robot-surgery-damaging-patients-rises-with-marketing
Burton TM. Report raises concerns on robotic surgery device. Wall Street J. 2013. http://www.wsj.com/articles/SB10001424052702304672404579186190568061568.
Lipschitz D. Robotic surgery is all the rage, but price is high creators online. Accessed 23 Dec 2013.
Heemskerk J, Bouvy ND, Baeten CGMI. The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery. Surg Endosc. 2014;28(4):1388–98.
Knowledge @ Wharton: medical innovation: when do the costs outweigh the benefits? 2013. http://knowledge.wharton.upenn.edu/article/medical-innovation-costs-outweigh-benefits/. Accessed 29 Jul 2018.
Emanuel EJ. OPINIONATOR; Op-Ed Contributor: In: Medicine, falling for fake innovation. New York Times 2012. https://query.nytimes.com/gst/fullpage.html?res=9F0CE5DA143EF93BA15756C0A9649D8B63&rref=collection%2Ftimestopic%2FEmanuel%2C%20Ezekiel%20J.&action=click&contentCollection=opinion®ion=stream&module=stream_unit&version=latest&contentPlacement=29&pgtype=collection.
Leape LL. Error in medicine. JAMA. 1994;272(23):1851–7.
PBS Newshour: the rundown. Kaiser Health News and Marissa Evans. 2013. http://www.pbs.org/newshour/rundown/mishaps-and-deaths-caused-by-surgical-robots-going-underreported-to-fda/
Langreth R. Unreported robot surgery injuries open questions for FDA. Bloomberg. 2013. https://www.bloomberg.com/news/articles/2013-12-30/unreported-robot-surgery-injuries-open-questions-for-fda.
Wright JD, Ananth CV, Tergas AI, et al. An economic analysis of robotically assisted hysterectomy. Obstet Gynecol. 2014;123(5):1038–48.
Dekker S. The field guide to understanding ‘human error’. 3rd ed. Boca Raton: CRC press; 2014. ISBN-13: 978-1472439055
Weinstein MC, Skinner JA. Comparative effectiveness and health care spending–implications for reform. N Engl J Med. 2010;362(5):460–5.
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Slakey, D.P., Davidson, I. Robotic surgery: an example of uncoupling the economics of technology. Health Technol. 9, 25–29 (2019). https://doi.org/10.1007/s12553-018-0249-z
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DOI: https://doi.org/10.1007/s12553-018-0249-z