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‘Cost-Effectiveness Analysis’ and U.S. Health Care

Tue, 12/29/2009 - 9:01am
The Institute for Health Technology Studies

Comparative effectiveness on the face of it is both needed and valuable. Why waste breath (or bandwidth) discussing whether we should know which diagnostic tool or therapy will work best for us?

But performing CE is easier said than done and it’s not going to be a panacea. For example, medical devices evolve at a much faster rate than drugs. So finding sufficient data to compare devices, or even to compare devices to drugs, is often difficult and made irrelevant through continuing innovation.

At non-profit InHealth, we look at the social and economic impact of diagnostic and therapeutic devices precisely because so little of this research is done elsewhere.  But we learn that even with data, making decisions about which technology might be better is not easy.

Our health system may be deficient in not having solid CE data. But this is a path to improving the health system not fixing our cost problems. I recommend anyone interested look at Shannon Brownlee’s Overtreated (Bloomsbury, New York, 2007) in which she writes: “the most powerful reason doctors and hospitals overtreat is that most of them are paid for how much care they deliver…. They get paid for doing more” (p. 8). Brownlee argues we currently spend $700 billion on unnecessary care (p. 11).

Get rid of that and we’d be healthier, wealthier and wiser. And the health care share of GDP would be around 11% – comparable to other industrialized nations.

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