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Print“Just as we need new and better tools for drug development, we need them for effective measurement as well.”
Like other cost-based practices, health technology assessment—an effort to manage the use of medical technologies by evaluating their cost effectiveness—is designed to reduce costs and restrict patient care. But, properly designed in a way to provide and pay for the best care for patients, it can also be patient-centric. Just as we need new and better tools for drug development, we need them for effective measurement as well.
Today, health technology assessment is a short-term, short-sighted, politically-driven policy that results in one-size-fits-all medicine. While it may provide transitory savings in the short-term, current strategies result in a lower quality of care that result in higher healthcare costs over time.
Restrictive formularies and health care systems that deny patients access to the right medicine in the right dose at the right time but pay for more invasive and expensive procedures later on have their priorities upside down.
So why is the current health technology assessment model enjoying such wide support? It is because it drapes a veil of pseudo-science around the blunt instrument of one-size-fits-all price controls.
I’ve just returned from a European road trip with Frank Lichtenberg, an economist and professor of business at Columbia University, where we spoke in Brussels, Rome, and Berlin on health technology assessment. I represented The Center for Medicine in the Public Interest, which is part of a transatlantic public policy institute consortium on the future of health technology assessment.
Conflicting Interests
On the other side of the pond, Sir Michael Rawlings, chairman of United Kingdom’s National Institute for Health and Clinical Excellence or NICE, told the British House of Commons that comparative effectiveness, a means of health technology assessment, is not based on empirical research. “There is no empirical research anywhere in the world, it is really based on the collective judgment of the health economists we have approached across the country,” he said. “It is elusive.”
The problem is that health technology assessment, as it is currently designed, places into conflict the short-term budgeting dilemmas of governments elected for relatively short periods of time with the ever-lengthening life spans of their electorates.
According to my traveling companion Lichtenberg, for health technology assessment to yield valid decisions in practice, it is necessary to have reliable estimates of not only cost, but the other inputs as well, such as QALY, a measure of the quality of life and VSLY, the value of a statistical life year. He believes that incorrect estimates of some or all of these key inputs are often used. Due to these estimation biases, health technologies that are truly cost-effective may often be rejected as cost-ineffective.
