Technology Assessment

  • Karl A. Matuszewski
Chapter

Summary

Who should ultimately decide what is standard therapy,state-of-the-art, or investiga- tional: juries, judges, politicians, scientists, providers,patients, or payers? This question has no clear answer. This chapter strongly recommends that health care administrators, providers, and payers should all be familiar with the elements of technology assessment as a means of monitoring the quality and cost-effectiveness of health care delivery and should utilize epidemiological information, particularly on utilization trends and studies of risks versus benefits of new technologies. Future health care administrators, as important decision makers in new technology acquisition, must possess a comprehensive understanding of the issues involved in the process of technology assessment as well as the ability to interpret the primary medical literature knowledgeably, using epidemiological methods to assess the relative merits and limitations of new technologies. In this way, proactive technology decisions will be made, not reactive decisions based on external pressures.

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References

  1. American College of Obstetricians and Gynecologists, 1988, New Guidelines for VBAC: Statement of the Committee on Obstetrics: Maternal and Fetal Medicine, ACOG, Washington, DC.Google Scholar
  2. American Medical Association, Council on Scientific Affairs, 1988, Application of positron emission tomography in the heart, JAMA 16:2438–2445.Google Scholar
  3. American Society of Health-System Pharmacists, 1999, American Hospital Formulary Service—Drug Information, Author, Bethesda, MD.Google Scholar
  4. Anderson, G. F, Hall, M. A., and Steinberg, E. P., 1993, Medical technology assessment and practice guidelines: Their day in court, Am. J. Pub. Health 83:1635–1639.PubMedGoogle Scholar
  5. Antiplatelet Trialists’ Collaboration, 1994, Collaborative overview of randomized trials of antiplatelet therapy—I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patient, Br. Med. J. 308:81–106.Google Scholar
  6. Appleby, C. R., 1991, HCFA told to cover lenses still in clinical trial, HealthWeek 5:4.Google Scholar
  7. Aubuchon, J. P., and Birkmeyer, J. D., 1994, Safety and cost-effectiveness of solvent-detergent-treated plasma: In search of a zero-risk blood supply, JAMA 272:1210–1214.PubMedCrossRefGoogle Scholar
  8. Bailar, J. C., III, 1997, The promise and problems of meta-analysis, N. Engl. J. Med. 337:559–561.PubMedCrossRefGoogle Scholar
  9. Bailar, J. C., III, and Mosteller, F., 1988, Guidelines for statistical reporting in articles for medical journals, Ann. Intern. Med. 108:266–273.PubMedGoogle Scholar
  10. Banta, H. D., and Thacker, S. B., 1990, The case for reassessment of health care technology: Once is not enough, JAMA 264:235–240.PubMedCrossRefGoogle Scholar
  11. Blue Cross and Blue Shield Association, Technology Evaluation Center, 1997, TEC Criteria, The Association, Chicago, IL.Google Scholar
  12. Bootman, J. L., Townsend, R. J., and McGhan, W. F. (eds.), 1996, Principles of Pharmacoeconomics, 2nd ed., Harvey Whitney Books, Cincinnati, OH.Google Scholar
  13. Braitman, L. E., 1991, Confidence intervals assess both clinical significance and statistical significance, Ann. Intern. Med. 114:515–517.PubMedGoogle Scholar
  14. Brown, W. S., and Newman, T. B., 1987, Are all significant p values created equal? The analogy between diagnostic tests and clinical research, JAMA 257:2459–2463.Google Scholar
  15. Calltorp, J., and Smedby, B., 1989, Technology assessment activities in Sweden, Int. J. Technol. Assess. Health Care 5:263–297.PubMedGoogle Scholar
  16. [The] CAPTURE Investigators, 1997, Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: The CAPTURE study, Lancet 349:1429–1435.Google Scholar
  17. Chalmers, T. C., Smith, H., Jr., Blackburn, B., Silverman, B., Schroeder, B., Reitman, D., and Abroz, A., 1981, A method for assessing the quality of a randomized control trial, Control. Clin. Trials 2:31–49.PubMedGoogle Scholar
  18. Chen, C., Danekas, L. H., Ratko, T. A., Vlasses, P. H., and Matuszewski, K. A., 2000, A multicenter drug use surveillance of intravenous immunoglobulin utilization in US academic health centers, Ann. Pharmacother. 34: 295–299.PubMedCrossRefGoogle Scholar
  19. Cochrane Injuries Group Albumin Reviewers, 1998, Human albumin administration in critically ill patients: Systematic review of randomised controlled trials—Why albumin may not work, Br. Med. J. 317:235–240.Google Scholar
  20. Connors, A. F, Speroff, T., Dawson, N. V., Thomas, C., Harrell, F. E., Wagner, D., Desbiens, N., Goldman, L., Wu, A. W., Califf, R. M., Fulkerson, W. J., Vidaillet, H., Broste, S., Bellamy, P., Lynn, J., and Knaus, W., for the SUPPORT Investigators, 1996, The effectiveness of right heart catheterization in the initial care of critically ill patients, JAMA 276:889–897.PubMedCrossRefGoogle Scholar
  21. Davis, K., 1990, Use of data registries to evaluate medical procedures, Int. J. Technol. Assess. Health Care 6:203–210.PubMedGoogle Scholar
  22. Detsky, A. S., 1989, Are clinical trials a cost-effective investment? JAMA 262:1795–1800.PubMedCrossRefGoogle Scholar
  23. Detsky, A. S., and Naglie, I. G., 1990, A clinician’s guide to cost-effectiveness analysis, Ann. Intern. Med. 113: 147–154.PubMedGoogle Scholar
  24. Diamond, G. A., and Denton, T. A., 1993, Alternative perspectives on the biased foundations of medical technology assessment, Ann. Intern. Med. 118:455–464.PubMedGoogle Scholar
  25. Eddy, D. M., 1989, Selecting technologies for assessment, Int. J. Technol. Assess. Health Care 5:485–501.PubMedGoogle Scholar
  26. Eddy, D. M., 1997, Breast cancer screening in women younger than 50 years of age: What’s next? Ann. Intern. Med. 127:1035–1036.PubMedGoogle Scholar
  27. Ferguson, J. H., Dubinsky, M., and Kirsch, P. J., 1993, Court-ordered reimbursement for unproven medical technology: Circumventing technology assessment, JAMA 269:2116–2121.PubMedCrossRefGoogle Scholar
  28. Fuchs, V. R., and Garber, A. M., 1990, The new technology assessment, N. Engl. J. Med. 323:673–677.PubMedGoogle Scholar
  29. Gelijns, A. C., and Rigter, H., 1990, Health care technology assessment in the Netherlands, Int. J. Technol. Assess. Health Care 6:157–174.PubMedGoogle Scholar
  30. Gill, T. M., and Feinstein, A. R., 1994, A critical appraisal of the quality of quality-of-life measurements, JAMA 272:619–626.PubMedCrossRefGoogle Scholar
  31. Gold, M. R., Siegel, J. E., Russell, L. B., and Weinstein, M. C. (eds.), 1996, Cost-Effectiveness in Health and Medicine, Oxford University Press, Oxford, England.Google Scholar
  32. Greenland, S., 1989, Modeling and variable selection in epidemiologic analysis, Am. J. Publ. Health 79:340–349.CrossRefGoogle Scholar
  33. Gross, P. F., 1989, Technology assessment in health care in Australia, Int. J. Technol. Assess. Health Care 5:137–153.PubMedGoogle Scholar
  34. Hodge, J. G., Gostin, L. O., and Jacobson, P. D., 1999, Legal issues concerning electronic health information: Privacy, quality, and liability, JAMA 282:1466–1471.PubMedCrossRefGoogle Scholar
  35. Hooper, D. C., and Wolfson, J. S., 1991, Fluoroquinolone antimicrobial agents, N. Engl. J. Med. 324:384–394.PubMedGoogle Scholar
  36. Institute of Medicine, Council on Health Care Technology, 1990, National Priorities for the Clinical Conditions and Medical Technologies, Report of a Pilot Study, National Academy Press, Washington, DC.Google Scholar
  37. [The] Ischemic Optic Neuropathy Decompression Trial Research Group, 1995, Optic nerve decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful, JAMA 273:625–632.Google Scholar
  38. Katerndahl, D. A., and Lawler, W. R., 1999, Variability in meta-analytic results concerning the value of cholesterol reduction in coronary heart disease: A meta-meta-analysis, Am. J. Epidemiol. 149:429–441.PubMedGoogle Scholar
  39. Koch, P. W., 1987, Government reimbursement policy and medical technology assessment: The case of Switzerland, Int. J. Technol. Assess. Health Care 3:607–612.PubMedGoogle Scholar
  40. Kohn, L., Corrigan, J., and Donaldson, M. (eds.), 1999, To Err Is Human: Building a Safer Health System, National Academy Press, Washington, DC.Google Scholar
  41. Larson, E. B., and Kent, D. L., 1989, The relevance of socioeconomic and health policy issues to clinical research, Int. J. Technol. Assess. Health Care 5:195–206.PubMedGoogle Scholar
  42. Laupacis, A. L., Sackett, D. L., and Roberts, R. S., 1988, An assessment of clinically useful measures of the consequence of treatment, N. Engl. J. Med. 318:1728–1733.PubMedCrossRefGoogle Scholar
  43. Laupacis, A., Feeny, D., Detsky, A. S., and Tugwell, P. X., 1992, How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can. Med. Assoc. J. 146:473–481.Google Scholar
  44. Leape, L., 1989, Unnecessary surgery, Health Serv. Res. 23:351–407.Google Scholar
  45. LeGales, C., and Moatt, J. P., 1990, Searching for consensus through multicriteria decision analysis: Assessment of screening strategies for hemoglobinopathies in southeastern France, Int. J. Technol. Assess. Health Care 6 : 430–449.Google Scholar
  46. MacDonald, D., Grant, A., Sheridan-Pereira, M., Boylan, P., and Chalmers, I., 1985, The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring, Am. J. Obstet. Gynecol. 152:524–539.PubMedGoogle Scholar
  47. Matuszewski, K., and Vermeulen, L., 1994, Medical technology assessment, in Critical Issues Shaping Medical Practice, University Hospital Consortium, Oakbrook, IL.Google Scholar
  48. McGivney, W. T, and Hendee, W. R., 1990, Regulation, coverage, and reimbursement of medical technologies, Int. J. Radial. Oncol. Biol. Phys. 18:697–700.Google Scholar
  49. Mosby-Year Book, Inc., 1996, Physicians GenRx, St. Louis, MO.Google Scholar
  50. Murphy, J. R., 1991, The assessment process: A microscopic view, Med. Prog. Technol. 17:77–83.PubMedGoogle Scholar
  51. National Institutes of Health, 1990, Intravenous Immunoglobulin: Consensus Statement 8, No. 5, NIH, Bethesda, MD.Google Scholar
  52. Office of Technology Assessment, 1976, Development of Medical Technology: Opportunities for Assessment, US Government Printing Office, Washington, DC.Google Scholar
  53. Ozminkowski, R. J., Wortman, P., and Roloff, D., 1987, Evaluating the effectiveness of neonatal intensive care: What can the literature tell us? Am. J. Perinatol. 4:339–347.PubMedCrossRefGoogle Scholar
  54. Park, R. E., Fink, A., Brook, R. H., Chassin, M. R., Kahn, K. L., Merrick, N. J., Kosecoff, J., and Solomon, D. H., 1986, Physician ratings of appropriate indications for six medical and surgical procedures. Am. J. Public Health 76:766–772.PubMedGoogle Scholar
  55. Perry, S., and Thamer, M., 1999, Medical innovation and the critical role of health technology assessment, JAMA 282:1869–1872.PubMedCrossRefGoogle Scholar
  56. Perry, S., Hanft, R., and Chrzanowski, R., 1991, Technology assessment reports. Int. J. Technol. Assess. Health Care 7:68–105.Google Scholar
  57. Perry, S., Garder, E. M., and Hong, R., 1998, Directory of Health Technology Assessment Organizations Worldwide, Medical Terminology and Practice Patterns Institute Press, Washington, D.C.Google Scholar
  58. Radensky, P., 1991, Federal activities related to health and economic outcomes, Administrative Radiology 54:53–55.Google Scholar
  59. Ratko, T. A., Burnett, D. A., Foulke, G. E., Matuszewski, K. A., and Sacher, R. A., 1995, Recommendations for offlabel use of intravenously administered immunoglobulin preparations, JAMA 273:1865–1870.PubMedCrossRefGoogle Scholar
  60. Ries, L. A. G., Eisner, M. P., Kosary, C. L., Hankey, B. F., Miller, B. A., Clegg, L., and Edwards, B. K. eds., 2000, SEER Cancer Statistics Review, 1973–1997, National Cancer Institute, Bethesda, MD.Google Scholar
  61. Rettig, R. A., 1997, Health Care in Transition: Technology Assessment in the Private Sector, Rand, Santa Monica, CA.Google Scholar
  62. Rimm, A. A., Barr, J. T, Horowitz, M. M., and Bortin, M. M., 1991, Use of a clinical data registry to evaluate medical technologies. Int. J. Technol. Assess. Health Care 7:182–193.PubMedCrossRefGoogle Scholar
  63. Rodenhuis, S., Richel, D. J., van der Wall, E., Schornagel, J. H., Baars, J. W., Koning, C. C., Peterse, J. L., Barger, J. H., Nooijen, W. J., Bakx, R., Dalesio, O., and Rutgers, E., 1998, Randomised trial of high-dose chemotherapy and haemopoietic progenitor-cell support in operable breast cancer with extensive axillary lymph-node involvement. Lancet 352:515–521.PubMedGoogle Scholar
  64. Schwartz, J. S., and Lurie, N., 1990, Assessment of medical outcomes: New opportunities for achieving a long sought-after objective, Int. J. Technol. Assess. Health Care 6:333–339.PubMedGoogle Scholar
  65. Schwartz, W. B., 1987, The inevitable failure of current cost-containment strategies, JAMA 257:220–224.PubMedGoogle Scholar
  66. Shulkin, D. J., Ratko, T. A., and Matuszewski, K. A., 1996, Model guidelines for the preoperative evaluation of patients undergoing elective surgery, J. Clin. Outcomes Manage. 3:39–48.Google Scholar
  67. Shy, K. K., Luthy, D. A., Bennett, F. C., Whitfield, M., Larson, E. B., van Belle, G., Hughes, J. P., Wilson, J. A., and Stenchever, M. A., 1990, Effects of electronic fetal heart rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants, N. Engl. J. Med. 322:588–593.PubMedCrossRefGoogle Scholar
  68. Steinbrook, R., and Lo, B., 1990, Informing physicians about promising new treatments for severe illnesses, JAMA 263:2078–2082.PubMedCrossRefGoogle Scholar
  69. Sugarman, S. D., 1990, The need to reform personal injury law leaving scientific disputes to scientists, Science 248:823–827.PubMedGoogle Scholar
  70. Sussman, J. H., 1991, Financial considerations in technology assessment, Top. Health Care Financ. 17:30–41.PubMedGoogle Scholar
  71. Thompson, W. D., 1987, Statistical criteria in the interpretation of epidemiologic data, Am. J. Publ. Health 77:191–194.Google Scholar
  72. Turner, D. A., Alcorn, F, Shorey, W. D., Stelling, C. B., Mategrano, V., Merten, C. W., Silver, B., Economou, S. G., Straus, A. K., Witt, T. R., and Norusis, M., 1988, Carcinoma of the breast: Detection with MR Imaging versus xeromammography, Radiology 168:49–59.PubMedGoogle Scholar
  73. Udvarhelyi, I. S., Colditz, G. A., Rai, A., and Epstein, A. M., 1992, Cost-effectiveness and cost-benefit analyses in the medical literature: Are the methods being used correctly? Ann. Intern. Med. 116:238–244.PubMedGoogle Scholar
  74. United States Pharmacopeial Convention, 1998, Drug Information for the Health Care Professional, Author, Rockville, MD.Google Scholar
  75. US Department of Health and Human Services, PHS, Agency for Health Care Policy Research, 1990, AHCPR Program Note, US Department of Health and Human Services, Rockville, MD.Google Scholar
  76. Veluchamy, S., and Saver, C. L., 1990, Clinical technology assessment, cost-effectiveness adoption, and quality management by hospitals in the 1990s, Qual. Rev. Bull. 16:223–228.Google Scholar
  77. Vermeulen, L. C., Matuszewski, K. A., Ratko, T. A., Burnett, D. A., and Vlasses, P. H., 1994, Evaluation of ondansetron prescribing in US academic medical centers, Arch. Intern. Med. 154:1733–1740.PubMedCrossRefGoogle Scholar
  78. Vermeulen, L. C., Ratko, T. A., Erstad, B. L., Brecher, M. E., and Matuszewski, K. A., 1995, A paradigm for consensus: The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions, Arch. Intern. Med. 155:373–379.PubMedCrossRefGoogle Scholar
  79. Ware, J. E., and Sherbourne, C. D., 1992, The MOS 36-item short-form health survey (SF-36), Med. Care 30:473–483.PubMedGoogle Scholar
  80. Wennberg, J. E., 1996, Dartmouth Atlas of Health Care, American Hospital Publishing, Chicago, IL.Google Scholar
  81. Yim, J. M., Matuszewski, K. A., Vermeulen, L. C., Ratko, T. A., Burnett, D. A., and Vlasses, P. H., 1995a, Surveillance of colony-stimulating factor use in U.S. academic health centers, Ann. Pharmacotherapy 29:475–481.Google Scholar
  82. Yim, J. M., Vermeulen, L. C., Erstad, B. L., Matuszewski, K. A., Burnett, D. A., and Vlasses, P. H., 1995b, Albumin and non-protein colloid solution use in U.S. academic health centers. Arch. Intern. Med. 155:2450–2455.PubMedCrossRefGoogle Scholar
  83. Young, F. E., 1988, Paying for Progress: Reimbursement and Regulated Medical Products, presented to the Blue Cross and Blue Shield Technology Management Conference, Chicago, November.Google Scholar
  84. Yusef, S., Peto, R., Lewis, J., Collins, R., and Sleight, P., 1985, Beta blockage during and after myocardial infarction: An overview of the randomized trials, Prog. Cardiovasc. Dis. 27:335–371.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Karl A. Matuszewski
    • 1
    • 2
  1. 1.Clinical Knowledge ServiceUniversity HealthSystem Consortium, Clinical Practice Advancement CenterOak Brook
  2. 2.Department of Health Systems ManagementRush UniversityChicago

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