Posted on Sept. 8: Funding helps researcher assess new technologies in health

[img_inline align=”right” src=”http://padnws01.mcmaster.ca/images/OBrien_Bernie_opt.jpg” caption=”Bernie OBrien”]A lack of evidence on the value of new health technologies has the Province of Ontario in a little bit of a conundrum. Without systematic comparative evidence on the effectiveness and efficiency of new medical technologies, how do they decide what should and should not be reimbursed?

With a $3-million grant over three years from the Ministry of Health and Long-Term Care, McMaster's Bernie O'Brien is hoping to provide some guidance.

Through a series of research studies, the co-director of the Centre for Evaluation of Medicines and director of the Program for Assessment of Technology in Health (PATH) will assess the economic benefit of new medical technologies, providing evidence to support government reimbursement decisions.

“Evaluation research is about trying to gather the evidence so the decision makers can make sensible decisions,” says the professor in the Department of Clinical Epidemiology and Biostatistics at McMaster. “They're tough choices because they involve trade-offs between different disease areas.”

O'Brien and his team of researchers will assess new therapeutic interventions, including the use of drug-eluting stents and positron emission tomography (PET) scanning.

With the new drug-coated stents, used for angioplasty procedures to open clogged coronary arteries, O'Brien is determining if it is worth paying thousands of dollars more for the new apparatus'. Normally, a stent is left permanently in the artery to keep the vessel open after angioplasty. Unlike regular stents, the new stent slowly releases a drug into the artery. An advantage of the new stents is that they may reduce the need for repeat angioplasty.

“There is a lot of excitement about these new stents,” says O'Brien, “but there is an interesting economic question embedded in this. By using these drug-coated stents, how many people are coming back to have redoes? How many of these am I avoiding by using the more expensive stent compared to the less expensive stent?”

The Ministry has provided doctors and hospitals with $12 million for the new drug-eluting stents on the proviso that they agree to participate in O'Brien's research study on the economic benefits of them. “Research is a key ingredient to evidence-based policy, it helps the Ministry of Health make a more informed decision.”

O'Brien is also studying the economics of PET scanners, a technology that allows physicians to examine the heart, brain, liver, tumors and muscle tissue in detail while the patient is alert. The traditional computed tomography (CT) scan shows only structural details within the brain.

“By using PET scanning in diagnostic work, does that result in better decisions and better patient outcomes,” O'Brien asks. “It's a better image and it may be more sensitive and specific, but does it change outcomes for patients?” He says the evidence that this is cost-effective is absent. As a result, the Ministry has launched a roll out of PET scanners, and will fund at least two randomized controlled trials.

Basically, he says, many of these new technologies are like new toys. Hospitals and doctors will always want the brightest and the best. “But part of our job is to say, 'should we always be paying for the latest twist in the technology?' It's like buying the latest DVD player. Compared to the basic model of a DVD is it really worth paying more?”

Photo caption: Bernie O'Brien reads a cost-benefit analysis book in his Centre for Evaluation of Medicines office. Photo credit: Chantall Van Raay