Innovations in medical technologies are one of the leading areas of economic growth in the world. Whether new technologies take the form of pharmaceutical, medical device, biotechnology, information technology of some combination of these innovations, the opportunities for both private enterprise and social welfare are substantial. However, these innovations are not without cost, and require reimbursement from either a privately or publicly financed health care delivery system to enter the marketplace. This course aims to provide knowledge of the concepts, data, and methodology required to critically evaluate new medical technologies in order to secure financial investment, reimbursement, and regulatory compliance objectives, such as FDA approval. The course is designed to provide understanding of the analytic tools needed to evaluate medical technologies. After completing this course, students will have the skills needed to: - Understand the reimbursement systems financing medical technology use. - Understand the role of government and regulatory agencies in the development and use of new medical technologies. - Identify a population to be served by a medical technology. - Use health care data to evaluate a medical technology. - Perform cost/benefit and cost/effectiveness analysis of a new technology.
3.2.3 Considerations
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來自 University of Minnesota 的課程
Medical Technology and Evaluation
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從本節課中
The Elements of Medical Technology Assessments
In this module we will discuss a variety of types of medical technology evaluation approaches and the types of assessments. We will go into detail about the pros and cons of each type of assessment as a way to illustrate situations where one approach may be better than another. Finally, we will also cover the details of the two fundamental features of any evaluation: measuring costs and benefits.
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Eric BarretteDirector of Research
Health Care Cost Institute
This is lesson 3.2.3 Unit Costs.
In the previous lesson, we briefly touched on the idea of a unit cost or
probably a price, at the end of the lesson.
In this lesson, we'll discuss a few more details and
considerations thinking about and using Unit Costs.
The first consideration, when thinking about unit costs,
applies to unit costs in the hospital setting.
It's important to remember that hospital charges
are not the same as hospital prices or costs.
A hospital charge is what the hospital lists as the charge for a service maybe
$200 for a surgery.
The price that's paid by Medicare of the insurers is likely less than
200 maybe that's 150, that would be the price of the service.
The cost of the service on the other hand is what it costs for
that hospital to actually provide or produce that surgery.
That maybe $125, that would mean that if
the insurer reimburses $150 for
what costs $125, the hospital makes $25.
In this sense, the unit cost that we'd be interested,
because it would be what applies to the patients, or
what the insurers would pay would be the price, not the charge, and not the cost.
Hospital charges can be adjusted to reflect costs by using the Medicare
cost to charge ratio found in the Medicare Cost Reports.
Although we're most interested in prices, costs are still a better approximation,
or a proxy for price, rather than charges.
Hospital prices for privately insured patients usually need to be calculated
using administrative claims data from a commercially insured population because
charges do not reflect directly the prices or
the cost of procedures and can lead to misleading results.
A second consideration is inflation, in other words, how prices change over time.
If we want to calculate prices over time, we could adjust for
that change in price over time using the consumer price index, or
we could more accurately adjust for the change in price over time
using the medical components of the Consumer Price Index.
The medical component is based specifically on medical care products and
services, rather than a collection of all products and services in the economy.
A third consideration for using unit costs,
is that of patient time and how to estimate a price for
patient time costs which don't usually have prices associated with them.
Patient time cost can be estimated by the wage rate
of the patients in the targeted intervention.
However, not all patients in the targeted intervention may have a wage rate.
Stay at home parents will have to have their wages imputed.
One way to do this is to find the age, gender, education,
labor experience of a housewife, if that is the person, and
we're trying to identify the price of the time cost for.
And then, impute the wage from our regression equation that estimates
the wages from all of these variables listed for the entire population.
Other groups of patients who won't necessarily have wages
are retired people or children.
Who may be receiving health care, but won't have wages that can be used to
estimate the time costs because they are not working, there's no productive time
cost that could be used to impute the wage like there is for stay at home parents.
However, there are time costs associated with leisure in a similar
approximation could be used to estimate the value of the wage based
on the value of leisure to retired individuals or children.
Another consideration, an example of wages or
prices that need to be imputed are those of informal caregivers.
Again, the approach is similar, so we'd find the age, gender,
education, labor experience of the informal caregiver population.
And impute the wage from a regression model
that estimates wages from all of the variables for
the entire population, not just the informal caregiver population.
In other words, this approach estimates
what the informal care giver would make if they were in the working population.
Now let's consider an example.
Suppose there's a person who has to stay home from her job as an attorney to care
for an ailing parent.
In this sense, this person is an informal caregiver, however they have a job.
In this case, we could use her actual wage rate as a proxy for
the unit cost, or price, of the informal care giving.
Finally, there's one more consideration about future costs.
We have discussed adjusting for inflation, but there is also a question of whether or
not to include future costs in the analysis at all.
Generally, future medical or healthcare costs should be included.
This is not a controversial practice if the costs that are included are associated
with the condition being treated by the intervention.
For example, cancer treatment today that prevents cancer growth or
cancer progression would include all costs
associated with preventing cancer in the future.
However, future medical or health care costs that are unrelated to
the intervention or condition that are being assessed are controversial.
These refer to any medical costs that would be included due to treating another
condition that resulted from treating the original condition.
For example, if we're trying to assess cancer treatments and
then include the cost of a heart attack.
Ten years from the start of the cancer treatment assessment because the person
lived for ten years after being treated for cancer rather than only five years.
It would be controversial to include the cost of the heart attack
in the assessment of the cancer treatment.
Although, there's no hard and fast rule about this and
it's up to the analyst to determine which costs to include.
Future costs generally should only include those associated with the condition or
intervention that's being assessed.
