Adopting New Medical Technology (1994) / Chapter Skim
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9. AUTOLOGOUS BONE MARROW TRANSPLANTATION: A MICROCOSM OF THE U.S. HEALTH CARE SYSTEM
9. AUTOLOGOUS BONE MARROW TRANSPLANTATION: A MICROCOSM OF THE U.S. HEALTH CARE SYSTEM
Pages 109-116
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From page 109... ...
McGIVNEY~ The controversy over the appropriate utilization of high-dose chemotherapyautologous bone marrow transplantation (HDC-ABMT) in the treatment of cancer epitomizes the debate in the United States over increasing expenditures for the application of health care technology (drugs, devices, procedures, and techniques)
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From page 110... ...
The shift toward using HDC-ABMT in earlier stages of the disease process is exemplified by the use of the regimen in stage II and III breast cancer and earlier stages of multiple myelomas. Additional factors influencing utilization include the use of regimens that involve tandem transplants, repeating HDCABMT at some predetermined interval after the first treatment and applying HDC-ABMT to treat the recurrence of a cancer anywhere from one to three years after the initial HDC-ABMT treatment.
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From page 111... ...
Rather, the NCI trials represent attempts by responsible parties to obtain objective data that can be incorporated into their processes for making these difficult decisions. OUTCOMES-BASED DECISIONMAKING The decade of the 1980s will be remembered as a period when the health policy community came to intellectual grips with the fact that the widespread utilization of some health care technologies was based upon no more than the "expert opinion" of a handful of proponents.
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From page 112... ...
Thus, payer denials have often lacked clinical, legal, and societal defensibility. JEtna Health Plans has implemented a process to directly address questions regarding the appropriateness of and coverage for the use of investigational treatments in terminally ill patients with cancer.
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From page 113... ...
On the basis of our experience at A? tna, the following proposal describes a system for guiding the introduction and use of health care technologies.2 PROPOSAL A national advisory body should be established to oversee the conduct of evaluative outcomes research on important new technologies.
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From page 114... ...
DISCUSSION HDC-ABMT crystallized the issues and concerns that have surrounded the debate over ways to deliver high-quality health care while controlling the rate of rise in health care expenditures. With over 1 million new cases of cancer diagnosed every year and with an approximate cost of $175,000 per procedure, HDCABMT is a rapidly diffusing technology that has significant implications for the expenditure of health care dollars.
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From page 115... ...
Or, will HDCABMT be prioritized as, for example, technology no. 798, with national health care funding available only for technologies 1 through 612?
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From page 116... ...
1992. High dose chemotherapy with autologous bone marrow transplantation for the treatment of metastatic breast cancer.
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