Cost Of New Technology Research Articles

Adoption rate and adoption cost of new technology: Economic surplus approach

This study investigated the adoption costs and adoption rate of maize production of farmers in the Limpopo province of South Africa. The results of the study showed that under new technology, there was an increase in the adoption rate of maize; however, farmers incurred proportional increases in adoption costs. The study concludes that the adoption of new technology is most likely to increase the cost of production, and farmers should be made aware and budget accordingly. Key words: Economic surplus, adoption, impact assessment, maize production.

Next-generation community genetics for low- and middle-income countries.

A recent report by the World Health Organization calls for implementation of community genetics programs in low- and middle-income countries (LMICs). Their focus is prevention of congenital disorders and genetic diseases at the population level, in addition to providing genetics services, including diagnosis and counseling. The proposed strategies include both newborn screening and population screening for carrier detection, in addition to lowering the incidence of congenital disorders and genetic diseases through the removal of environmental factors. In this article, we consider the potential impact of such testing on global health and highlight the near-term relevance of next-generation sequencing (NGS) and bioinformatic approaches to their implementation. Key attributes of NGS for community genetics programs are homogeneous approach, high multiplexing of diseases and samples, as well as rapidly falling costs of new technologies. In the near future, we estimate that appropriate use of population-specific test panels could cost as little as $10 for 10 Mendelian disorders and could have a major impact on diseases that currently affect 2% of children worldwide. However, the successful deployment of this technological innovation in LMICs will require high value for human life, thoughtful implementation, and autonomy of individual decisions, supported by appropriate genetic counseling and community education.

The economic evaluation of health technologies in Cuba: results achieved and challenges for the country

The aim of the paper is to describe the importance and need for the implementation of the economic evaluation of health technologies for increasing efficiency in the field of health in Cuba, as well as exposing the implementation of this activity in the National Health System (NHS) and projections of work being developed in the country. We performed a literature review to search for information on this subject at national and international level to gauge the incorporation of this discipline as an element to increase efficiency in the Cuban health system. The economic evaluation applied to the health field in Cuba is considered an aspect that contributes to the efficient use of resources. Although the costs of new technology are large, their value in terms of efficiency can identify the most effective and less costly ways to support the process of decision-making. In conclusion, the economic evaluation of health technologies has become a necessity for the NHS, since its incorporation can guide decision-making to increase the efficiency of health interventions.

The adoption of new technology in radiation oncology should rely on evidence-based medicine

The adoption of new technology in radiation oncology should rely on evidence-based medicine

Focus

Focus

The War on Cancer: Progress at What Price?

The War on Cancer: Progress at What Price?

A sub rosa world: Medicare and the cost of new technology

The cost of medical care, particularly new medical technologies, continues to rise. This article examines how Medicare struggles to confront the challenge of shaping coverage decisions for expensive new technologies in light of political pressure to restrain cost, imperfect information about the effectiveness of new technologies, and a limited scope of power for how these decisions can be made. This article argues that, while these coverage decisions must be made with express reference to evidence of effectiveness, the interpretation of this evidence is distorted by hidden cost concerns by both Medicare and those who seek coverage.

Valuing health technologies at nice: recommendations for improved incorporation of treatment value in HTA

Pricing, reimbursements and coverage decisions for medical innovations and services are complex. In many countries, valuing medical technologies is the responsibility of national health-care systems that strive for distributive efficiency under fiscal constraints on medical spending. In the UK, the National Institute for Health and Clinical Excellence (NICE) is charged with the difficult task of assessing new and existing medical technologies, and making recommendations that guide NHS coverage decisions. These are responsibilities that NICE carries out rigorously and with the objective of achieving efficiency in the allocation of NHS resources. Nevertheless, the current process of health technology appraisal (HTA) has been criticized for failure to systematically incorporate important sources of value from new innovations. In maintaining NICE’s current approach to HTA, the UK risks suboptimal patient outcomes and social welfare relative to what could be achieved if limited NHS resources were targeted toward those technologies with greatest social value. Perhaps recognizing these limitations, NICE commissioned Professor Sir Ian Kennedy in January, 2009, to carry out a study of valuing innovation aimed at addressing the approach that should be adopted by NICE to ensure that innovation is properly taken into account when establishing the value of new health technologies; whether particular forms of value be considered more important than others; how should innovation in health technologies be defined and understanding the relationship between innovation and value. As part of this process, we were asked to present our views on what such new approaches may be and how they could be implemented in practice within the NICE regulatory framework. This work was presented to the Kennedy Commission on May 19, 2009. We discuss these approaches below, and expand on ways in which important value dimensions can be integrated within the current framework. While framed in response to the Kennedy study, these views are broadly applicable to other health-care systems charged with valuing innovation and achieving distributive efficiency.

Moore's Law and energy and operations savings in the evolution of optical transport platforms

As a telecommunications equipment vendor, we have witnessed a tremendous increase in the capacity of transport equipment over the past 16 years. Platforms have evolved from the first generation add/drop multiplexer to the next generation multiservice provisioning platform and today's packet optical transport platform. This article discusses our findings in the application of Moore's Law to these optical transport platforms in capacity, power, space, and capital cost. It also discusses our findings in using Moore's Law as a presumption to explore the operations cost savings in power consumption, office floor space, and maintenance. Payback periods for the capital cost of new technology from energy and operations savings are investigated. The conclusions justify the replacement of the network technology for every other generation.

Health economic issues in the treatment of drug-resistant serious Gram-positive infections

Escalating health care costs have stimulated a paradigm change in the way health care is delivered, reimbursed, and evaluated. Reducing the length of hospital stay and controlling the cost of new technologies and therapies are major factors driving health care decisions. Economic evaluations have had variable success in the decision-making process, partly due to the overall quality, interpretation, and reporting of published analyses. Compared with other Gram-positive pathogens, the economic impact of methicillin-resistant Staphylococcus aureus (MRSA) infections remains the most studied. MRSA infections clearly represent a significant clinical and fiscal burden and future studies analyzing cost-effective strategies that encompass their prevention and optimal management would be beneficial. These studies would need to be carefully designed with clear objectives and explicit perspectives at the onset. Use of an appropriate reference group is key in the design process to measure the true impact of MRSA infections. Health-economic outcome data of the impact of linezolid compared with glycopeptides remain the most robust data available in this therapeutic area.

Induced innovation and marginal cost of new technology

Lacking data on development and implementation costs for input-saving technologies, we develop a nonparametric procedure to estimate relative differences in marginal technology costs for technical change to be consistent with the induced innovation hypothesis. We apply it to U.S. agriculture.

Diversity in Public Views Toward Stem Cell Sources and Policies

Studies of public views on stem cell research have traditionally focused on human embryonic stem cells. With more recent scientific research on developing other stem cell sources, a series of focus group studies was undertaken with Canadian adults to examine their views on different stem cell sources (adult, umbilical cord blood, human embryonic stem cells, somatic cell nuclear transfer or SCNT, and interspecies nuclear transfer, or iSCNT). Views on three different policy models--a permissive, middle-of-the-road and restrictive policy approach--were also explored. Participants were recruited from several different social groups including patients, young adults, seniors, members of two ethnic communities, and a mixed group of adults. Participants were generally supportive of the use of adult stem cell sources. While there was also majority support for the use of hESC and SCNT, this was conditional on strict regulatory oversight. There was also majority support for a permissive policy which allows research on hESC and SCNT. General themes that cut across different groups included the potential cost of new technologies to the health care system, issues around who would gain access to these technologies, and trust in the scientific establishment and regulatory systems. A diversity of viewpoints was found as participants justified their positions on stem cell sources and policy approaches, showing more complexity and nuance than has been generally portrayed.

Healthcare costs for new technologies

Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed.

Obstetrician-Gynecologists' Opinions about Patient Safety: Costs and Liability Remain Problems; Are Mandated Reports a Solution?

To elucidate the patient safety practices of obstetrician-gynecologists (OB/GYNs), the perceived barriers to patient safety improvements in obstetrics and gynecology, and OB/GYN's beliefs about mandated reporting. A sample of 600 OB/GYNs was sent a survey from the American College of Obstetricians and Gynecologists about their beliefs and practice regarding patient safety. The response rate was 53.2%. More than 92% of respondents said that patient safety is important in women's health care. The most important barriers to improving patient safety were cost of new technologies and concern about liability. Half agreed that mandatory reporting would improve patient safety. Physicians who practice in states with mandated error reporting were no more or less likely to think that these mandates improve patient safety than physicians who do not work in states with mandates. Physicians who practice in states with "I'm Sorry" laws more strongly disagreed that mandates improve patient safety than physicians who do not work in states with "I'm Sorry" laws. It may be effective to aim at making patient safety activities more affordable to increase implementation. In addition, the effects of reporting and disclosure laws on physicians' concerns with liability should be examined more closely.

S268 – Cost-Effective Balloon Sinuplasty

Objectives Balloon sinuplasty is a new procedure that is gaining popularity in the United States. However, with all new technology, there is an increase in cost. Balloon sinuplasty increases the overhead for the facility where it is being performed and does not affect reimbursement. To decrease the cost of new technology, the physician, facility, and the company must all think of creative methods to acheive this goal. Methods In our institution, we had 60 patients that had balloon sinuplasties performed, with all of them involving both maxilary and frontal sinus. Re-useable olive-tip cannula was used instead of the company's recommended disposable guide catheter for the frontal and maxillary sinuses. In using the olive-tip as a guide catheter, the guide wire and balloon catheter are easily directed to the opening of both the maxillary and frontal sinus. Results The outcome from all 60 patients was successful, with none returning for revision. In using the olive-tip cannula instead of the disposable catheter guide for the maxillary and frontal sinuses, there was a savings of $37,500 for the institution. Conclusions The use of an olive-tip cannula from the basic FESS set decreases the cost of performing balloon sinuplasty. This suction-tip can replace the catheter guide without compromising the surgical procedure and is easy to use by the experienced sinus surgeon. There was a cost savings of $625 per procedure when using an olive-tip cannula instead of the company's recommended catheter guide.

Reducing Burden and Sample Sizes in Multiday Household Travel Surveys

Traditional household travel surveys ask respondents to report their travel behavior for a 24-h period, even though it is well known that travel patterns vary from day to day. Although this information provides an indication of average household behavior or travel on an average weekday, evidence suggests this method may not be the most cost-effective way to collect the data because day-to-day travel variability is substantial, requiring larger sample sizes. In addition, collecting multiday data provides a richness of information that simply cannot be captured with a 1-day survey, offering insights into, for example, differences in weekday versus weekend travel, the longer-term travel impacts of flexible work hours, and trip substitution and cycling patterns that emerge over the course of a week or more. Despite the intuitive appeal of multiday surveys, few examples and little information on sampling issues and sample size requirements are available. Given this situation, the reasons given for not doing multiday surveys (which center around respondent fatigue), why these issues are fast becoming irrelevant (through the use of new passive data-recording technologies), the sample size implications of extending a survey, and the potential for estimator efficiency and cost savings (even accounting for the cost of new technologies) when conducting multiday surveys are explored. The use of Global Positioning System–based travel distance data from Adelaide, South Australia, indicates that the sample size reductions are large; collecting multiday data is feasible, offering a richness not available in 1-day data; and the method results in cost-effective gains in estimator efficiency.

Laparoscopic and Open Partial Nephrectomy: Cost Comparison with Analysis of Individual Parameters

Laparoscopic partial nephrectomy (LPN) is less morbid than open partial nephrectomy (OPN), but the high cost of new technologies used in LPN may make this a significantly more expensive procedure. In this study, the overall costs of OPN and LPN were compared using data extracted from the literature, and a series of sensitivity analyses were performed to determine the impact of individual cost components on overall cost. Data on operating room (OR) time, equipment use, and length of stay (LOS) were abstracted after a comprehensive literature review of LPN and OPN. Decision tree models were devised to estimate the cost of each treatment using the DATA program (TreeAge software 3.5). LPN model assumptions included one that used all reusable equipment, all disposable equipment, and a hand-assist model. One and two-way sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost. The literature yielded 12 OPN and 13 LPN articles, comprising a total of 574 and 949 patients, respectively. The weighted mean LOS were 5.7 and 2.9 days (<0.001); average tumor sizes were 3.2 cm and 2.5 cm (P = 0.016); and the weighted mean OR times were 184 and 187 minutes for OPN and LPN (P = 0.7), respectively. The LPN model using all disposable equipment is less costly than OPN by $431 ($8450 v $8019). The slight cost superiority of the laparoscopic approach was driven by shorter LOS. One-way sensitivity analyses showed that LPN is less costly if the OR time of LPN is less than 146 minutes; LOS after LPN is less than 4.6 days; or LPN OR supply costs are less than $1670. Two-way sensitivity analyses demonstrated the effects of modifying OR time, LOS, and surgical equipment on the cost-equivalence of LPN and OPN. Laparoscopic partial nephrectomy can be cost equivalent to the open approach in managing small renal masses if the OR time, LOS, and equipment costs are closely monitored. The high cost of new technologies can be offset by shorter LOS and decrease in OR time.

Impact of new medical technologies on health expenditures in Israel 2000–07

The aim of this study was to estimate the impact of new medical technologies on public healthcare expenditures in Israel over the period 2000-07. For each year, government estimates for the costs of new technologies recommended as high-priority for public funding were summarized. The ratio of projected costs of these technologies to total public healthcare expenditures was calculated and compared with actual governmental budget allocations for new technologies. Funding all new high-priority medical technologies would have increased healthcare expenditures by 2.1 percent per year. Government allocations for new technologies raised expenditures by 1.0 percent per year. New medical technologies significantly increase healthcare expenditures in Israel. Budgetary constraints have reduced their actual impact by 52 percent. This study indicates the need for an annual addition of 2 percent to public healthcare budget for funding new high-priority technologies.

A Strategic Action Plan for Achieving Uncompromising "Treat to Target" in Individuals with Insulin-Dependent Diabetes: A Report by the Center for Insulin-Dependent Diabetes Access' Blue Ribbon Panel

The Center for Insulin-Dependent Diabetes Access, created by the Juvenile Diabetes Research Foundation International and funded by an unrestricted grant from The Medtronic Foundation, convened a Blue Ribbon Panel (the Panel) to identify barriers to achieving universal treatment-to-target in patients with insulin-dependent diabetes and to recommend solutions for addressing those barriers. The Panel was comprised of experts in diabetes care and included providers, academicians, researchers, payers, patient advocates, and policymakers. After reviewing the latest research on diabetes care, the Panel made six overall findings that identify barriers to achieving optimal diabetes care and made recommendations to address those barriers that are intended to achieve the goal of universal, uncompromising "Treat to Target" in insulin-dependent patients. The Panel's findings were: Finding 1: Improving care of patients with insulin-dependent diabetes depends on the public availability and ongoing collection of data that document patient characteristics, processes of care, health outcomes, the benefits and costs of new technologies, and the benefits and costs of different care models. Finding 2: Availability of new technologies and information systems for monitoring and treating insulin-dependent diabetes is critical to achieving recommended hemoglobin A1c levels. Finding 3: Increased reimbursement for new technologies and services provided by the "team" approach to medical management, such as coordinated non-face-to-face care and Internet communications, is imperative to achieving optimal diabetes care. Finding 4: Improving access to endocrinologists, certified diabetes educators, and adopting a chronic care or "team" approach to treating insulin-dependent diabetes are critical to achieving a "Treat to Target" objective. Finding 5: Primary care providers and individuals with insulin-dependent diabetes need to better understand the importance and impact of intensive insulin management and the "team" approach for treating diabetes in improving quality of life and reducing the incidence of long-term diabetes-related complications. Finding 6: Demographic characteristics of individuals with insulin-dependent diabetes require innovative approaches to patient education, outreach, and patient-centric care in order to achieve a "Treat to Target" objective. In the detailed report that follows, each finding is accompanied by a series of recommended action items intended to address the barriers that the Panel identified. A number of entities and organizations have ongoing and planned activities intended to improve diabetes care, particularly for individuals with insulin-dependent diabetes. The Panel recommended that the diabetes community work to coordinate those efforts in order to avoid duplication and ensure more effective program management of those activities.

Factors Affecting U.S. Manufacturers’ Decisions To Produce Vaccines

Recent supply interruptions of childhood vaccines have had negative impacts on U.S. public health policies and vaccine delivery. To understand how manufacturers perceive production incentives and disincentives, the Centers for Disease Control and Prevention (CDC) met with the four pharmaceutical firms that sold vaccines through CDC-negotiated contracts during 2002 and 2003. These meetings shed light on the regulatory burden, high costs of the delay between initial investment and sales, and higher costs of new technologies versus older vaccines. All four manufacturers are investing more in research and development because new technologies have advanced their ability to create vaccines not thought possible before.