A Changing Paradigm in the Study and Adoption of Emerging Health Care Technologies: Coverage With Evidence Development

Abstract

The rapid pace of the development and introduction to the marketplace of new medical technologies has been identified as one of the primary drivers of the increasing cost of health care delivery in the United States. The purpose of this study is to evaluate the role of the wide divergence of interests of the various stakeholders in contributing to the increasing cost of care. A literature review and analysis are performed to evaluate the primary and secondary cost drivers of health care technology costs in the United States. Technology developers, health care providers, patients and family members, and payers are the primary drivers of health care costs. Technology developers, vendors, and investors look primarily to a rapid return on investment that can be achieved only by expeditious introduction, payment, and user acceptance. Health care providers who should be primarily interested in patient care and outcomes may also be driven by a legitimate belief in the improvements a new technology may offer, competitive behavior, reimbursement motives, or personal career and institutional ambition. Patients and family members are frequently driven by a sense that new is by definition better and that the most recently introduced technologies are superior to older, more tested modalities. Payers are motivated primarily by a desire to stabilize or reduce cost (and increase profitability). Regardless of intentions or desires, it is increasingly apparent that the introduction of new technologies absent "significant evidence" that they are cost effective or add to the existing armamentarium places an increasing burden on a health care delivery system already stretched thin. These pressures have necessitated an increased level of interest in a variety of solutions to generate more appropriate and useful "evidence" of benefit. This discussion focuses on the emergence of a reimbursement methodology termed "coverage with evidence development" and how the radiation oncology and general oncology communities may participate.