Transcript Powerpoint

Technology and
Health Care
HCA 701
November 10, 2005
Technology Assessment
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The process that examines the available evidence to
form a conclusion as to the merits or role of a particular
technology in relation to its possible use, purchase or
reimbursement in current medical practice.
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Examines the safety, effectiveness, efficiency and
appropriateness
Includes medical devices, procedures and standards, and
pharmaceuticals
To maximize quality: the most effective health care
service that science can provide
Can we afford it?
Categories of Technology
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Devices - "the quiet heroes of health-care innovation"
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Diagnostic devices (MRI, CAT, SPECT, etc.)
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Treatment devices
Medical and surgical procedures (examples):
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Radial keratotomy used to improve vision.
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Genetic testing
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Treatment head injuries, cancers, joint replacements, etc.
Pharmaceuticals
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Efficient and appropriate uses for FDA approved drugs
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Labeling – language used to delineate the clinical use of a
drug (indications, dosage, adverse effects, etc.).
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Understanding the long-term affects of uses of some drugs,
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Understanding alternative uses for drugs (e.g., manoxodil)
Technology Life Cycle
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Investigation – laboratory and clinical studies to
discover or create, refine and package a new
diagnostic or treatment modality.
Promotion – introducing the technology into the buying
community.
Acceptance and utilization – incorporating the
technology into practice.
Decline – as technology is supplanted by superior new
technology.
Obsolesce – when the new technology is obsolete and
no longer appropriate.
Targeting Technologies for
Assessment
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Improve individual patient outcome
Positively affect a large population
Reduce treatment costs
Reduce unexplained treatment variation.
Three Components of Technology
Assessment
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High Utilization
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Potential for Harm
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Rapidly increase uses of a technology may signal inappropriate
or excessive utilization. (e.g., Cesarean births rates)
Uses of high technology for common conditions may be
inappropriate
E.g., use of mammography for women under the age of 50 has
sparked controversy on the practice of high technology.
Requires different standards and assessment priorities for
different risk factors in patients.
High Cost – willingness of payers to pay form some
technological procedures or diagnoses.
Performing Technology
Assessment
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Scientific assessment: does it work?
Clinical assessment: does it work better than
something that already exists?
Economic assessment: Cost (use of Cost
benefit analysis).
Social or societal issues:
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will providers use it?
Will patients use it?
Are secondary benefits more detrimental than
primary benefits?
Problems in Performing
Technology Assessment
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Lack of Evidence (not enough literature or patients to
study, or poorly conducted research)
Lack of Agreement on How to Perform the Assessment
(may lead to different results using different techniques)
Inconsistent Evidence (may result from different or
inconsistent research methods)
Legal Interference (can be influenced from biased
resources)
Breadth of Topics (difficult to successfully study or
assess all technologies)
New Information (assessment process must be ongoing
to adequately compare new uses)
The Impact of Pharmaceuticals on
Health Care
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Prescription drugs account for more than 15% of
health care spending ($162 billion)
Faster growth than all other segments of health
care
Prescription drug coverage over the last 10
years has been a catalyst for growth
Primarily a large multinational corporate
enterprise
 10
largest pharmaceutical companies accounted for
60% of all Rx sales in U.S. in 2004
Components of Pharmaceutical
Development
Manufacturing and Production
 Research and Development
 Selling and Promotion
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Top 10 Pharmaceutical Companies,
U.S.
Sales
2004
Corp.
U.S. Sales in
% Growth over
% Market Share
(Billions)
previous year
$30.7
5
13.1
Glaxo Smith Kline
18.8
1
8.0
J&J
16.2
7
6.9
Merck & Co.
15.0
8
6.4
Astra Zenneca
11.3
13
4.8
Novartis
10.2
7
4.3
Sanofi-Aventis
10.0
13
4.3
Amgen
9.5
23
4.1
Bristol-Myers
Squibb
9.2
-4
3.9
Wyeth
8.2
11
3.5
Pfizer
Total Top 10
139.1
59.3
Top 10 Products 2004
Product
Lipitor
HYCD/APAP
Synthroid
Norvasc
Toprol
Zoloft
Zocor
HYCD/APAP
Albuterol
Amoxicillin
Manufacturer Rx in Millions Market Share
Pfizer
Mallinckrodt
Abbot
Pfizer
74.8
49.5
47.4
38.3
2.1
1.4
1.3
1.1
AstraZeneca
Pfizer
Merck
35.0
33.1
29.6
1.0
0.9
0.8
Watson
Warrick
Teva
29.0
26.8
26.2
0.8
0.8
0.7
Where the promotional money
goes (In Billions of Dollars)
12
10
Retail Value of
Sampling
Detailing
8
6
Direct to Consumer
Advertising
Professional Journal
Advertising
4
2
0
1996
1997
1998
1999
2000
2001
Major Issues for Prescription Drug
Policy
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Consumerism and the results of direct to
consumer marketing
Brand drugs vs. generic drugs
 Benefits
 Controlling
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patents
Drug importation
Government’s role in controlling prices
 Can
the market place take care of this?