Machines that Go 'Ping': Medical Technology and Health Expenditures in OECD Countries

Design of a multiple criteria decision analysis framework for prioritizing high-impact health technologies in a regional health service

OBJECTIVES

This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies.

METHOD

Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494).

RESULTS

The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were "Need for intervention" and "Intervention outcomes." The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples.

CONCLUSIONS

A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.

Determinants of life-expectancy and disability-adjusted life years (DALYs) in European and Organisation for Economic Co-operation and Development (OECD) countries: A longitudinal analysis (1990-2019)

•We relate 68 factors to population health observed in 61 countries over 30 years.•Using random forests, multiple imputation and generalized estimating equations.•GDP per capita and demographics are key; income inequality is not.•Health and social expenditure are more influential than freedom and corruption.•On the macro-level, life-style effects appear to be mediated by cultural context.

Magnetic Resonance Imaging in the Year Prior to Total Knee Arthroplasty: A Potential Overutilization of Healthcare Resources

BACKGROUND

Total knee arthroplasty (TKA) is a common procedure for late-stage degenerative changes, a situation for which magnetic resonance imaging (MRI) is typically not considered useful. In an era attempting to contain healthcare expenditures, the rate, timing, and predictors for MRI before TKA were assessed in a large, national, administrative data set.

METHODS

The 2010 to Q3 2020 MKnee PearlDiver data set was used to identify patients undergoing TKA for osteoarthritis. Those with lower extremity MRI for knee indications within 1 year before TKA were then defined. Patient age, sex, Elixhauser Comorbidity Index, region in the country, and insurance plan were characterized. Predictors of having had an MRI were assessed by univariate and multivariate analyses. The costs and timing of the obtained MRIs were also assessed.

RESULTS

Of 731,066 TKAs, MRI was obtained within 1 year prior for 56,180 (7.68%) with 28,963 (51.9%) within the 3 months of TKA. Independent predictors of having had an MRI included younger age (odds ratio [OR], 0.74 per decade increase), female sex (OR, 1.10), higher Elixhauser Comorbidity Index (OR, 1.15), region of the country (relative to South, Northeast OR, 1.08, West OR, 1.22, Midwest OR, 1.36), and insurance (relative to Medicare, Medicaid OR, 1.36 and Commercial OR, 1.35) with P < 0.0001 for each. The total cost of MRIs among patients who received a TKA is $44,686,308.

CONCLUSION

Noting that TKA is typically done for advanced degenerative changes, MRI should rarely be indicated in the preoperative period for this procedure. Nonetheless, this study found that MRI was done within the year before TKA for 7.68% of the study cohort. In an era striving for evidence-based medicine, the almost $45 million dollars spent on MRI in the year before TKA may represent overutilization.

Age, morbidity, or something else? A residual approach using microdata to measure the impact of technological progress on health care expenditure

This study measures the increment of health care expenditure (HCE) that can be attributed to technological progress and change in medical practice by using a residual approach and microdata. We examine repeated cross-sections of individuals experiencing an initial health shock at different point in time over a 10-year window and capture the impact of unobservable technology and medical practice to which they are exposed after allowing for differences in health and socioeconomic characteristics. We decompose the residual increment in the part that is due to the effect of delaying time to death, that is, individuals surviving longer after a health shock and thus contributing longer to the demand of care, and the part that is due to increasing intensity of resource use, that is, the basket of services becoming more expensive to allow for the cost of innovation. We use data from the Danish National Health System that offers universal coverage and is free of charge at the point of access. We find that technological progress and change in medical practice can explain about 60% of the increment of HCE, in line with macroeconomic studies that traditionally investigate this subject.

How does regulating doctors' admissions affect health expenditures? Evidence from Switzerland

Background

Cost containment is a major issue for health policy, in many countries. Policymakers have used various measures to deal with this problem. In Switzerland, the national parliament and subnational (cantonal) governments have used moratoriums to limit the admission of specialist doctors and general practitioners.

Methods

We analyze the impact of these regulations on the number of doctors billing in free practice and on the health costs created by medical practice based on records from the data pool of Swiss health insurers (SASIS) from 2007 to 2018 using interrupted time series and difference-in-differences models.

Results

We demonstrate that the removal of the national moratorium in 2012 increased the number of doctors, but did not augment significantly the direct health costs produced by independent doctors. Furthermore, the reintroduction of regulations at the cantonal level in 2013 and 2014 decreased the number of doctors billing in free practice but, again, did not affect direct health costs.

Conclusions

Our findings suggest that regulating healthcare supply through a moratorium on doctors’ admissions does not directly contribute to limiting the increase in health expenditures.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12913-022-07735-7).

Budget Impact Analysis of Biosimilar Products in Spain in the Period 2009-2019

Since the first biosimilar medicine, Omnitrope^® (active substance somatropin) was approved in 2006, 53 biosimilars have been authorized in Spain. We estimate the budget impact of biosimilars in Spain from the perspective of the National Health System (NHS) over the period between 2009 and 2019. Drug acquisition costs considering commercial discounts at public procurement procedures (hospital tenders) and uptake data for both originator and biosimilar as actual units consumed by the NHS were the two variables considered. Two scenarios were compared: a scenario where no biosimilars are available and the biosimilar scenario where biosimilars are effectively marketed. All molecules exposed to biosimilar competition during this period were included in the analysis. The robustness of the model was tested by conducting multiple sensitivity analyses. From the payer perspective, it is estimated that the savings produced by the adoption of biosimilars would reach EUR 2306 million over 11 years corresponding to the cumulative savings from all biosimilars. Three molecules (infliximab, somatropin and epoetin) account for 60% of the savings. This study provides the first estimation of the financial impact of biosimilars in Spain, considering both the effect of discounts that manufacturers give to hospitals and the growing market share of biosimilars. We estimate that in our last year of data, 2019, the savings derived from the use of biosimilars relative total pharmaceutical spending in Spain is 3.92%. Although more research is needed, our evidence supports the case that biosimilars represent a great opportunity to the sustainability of the NHS through rationalizing pharmaceutical spending and that the full potential of biosimilar-savings has not been achieved yet, as there is a high variability in biosimilar uptake across autonomous regions.

On the Network Transmission Mechanisms of Disease-Specific Healthcare Expenditure Spillovers: Evidence from the Connectedness Network Analyses

Previous studies investigating factors influencing healthcare expenditure growth ignored the network transmission mechanisms of disease-specific healthcare expenditure spillovers and regarded the processes culminating in healthcare expenditure growth as a black box. In this study, we investigated factors influencing the network transmission mechanisms underlying the determinants of healthcare expenditure growth through the dynamic connectedness network and the robust least square regression analyses. Our results indicate that demographic transition and business cycles are key factors increasing interconnectedness of different disease-specific healthcare expenditures, and that promotion of primary care utilization would reduce total healthcare expenditure spillovers. In order to reduce diffusion of disease-specific healthcare expenditures, health promotion activities should focus on those clinical diagnosis-related groups of diseases classified as pure net transmitters of spillover, and preventive interventions targeting different diseases should be activated in different phrases of the business cycle.

Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology

Healthcare expenditure is continually increasing and projected to accelerate in the future, with an increasing proportion being spent on interventional radiology. The role of cost effectiveness studies in ensuring the best allocation of resources is discussed, and the role of National Institute of Health and Care Excellence (NICE) in determining this. Issues with demonstrating cost effectiveness have been discussed, and it has been found that there is significant scope for improving cost effectiveness, with suggestions made for how this can be achieved. In this way, more patients can benefit from better treatment given limited healthcare budgets.

The reimbursement of new medical technologies in German inpatient care: What factors explain which hospitals receive innovation payments?

Most hospital payment systems based on diagnosis-related groups (DRGs) provide payments for newly approved technologies. In Germany, they are negotiated between individual hospitals and health insurances. The aim of our study is to assess the functioning of temporary reimbursement mechanisms. We used multilevel logistic regression to examine factors at the hospital and state levels that are associated with agreeing innovation payments. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n = 1532). Using agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances, the study comprises all German acute hospitals and innovation payments on all diagnoses. In total, 32.9% of the hospitals successfully negotiated innovation payments in 2013. We found that the chance of receiving innovation payments increased if the hospital was located in areas with a high degree of competition and if they were large, had university status and were private for-profit entities. Our study shows an implicit self-controlled selection of hospitals receiving innovation payments. While implicitly encouraging safety of patient care, policy makers should favour a more direct and transparent process of distributing innovation payments in prospective payment systems.

Analyzing inappropriate magnetic resonance imaging (MRI) prescriptions and resulting economic burden on patients suffering from back pain

INTRODUCTION

Back pain is a common global disorder and magnetic resonance imaging (MRI) is one method of assessing its cause. The lack of official and general clinical guidelines is the cause of inadequate supervision of lumbar MRI prescriptions. The goal of this research was to analyze inappropriate lumbar MRI prescriptions and the resulting economic burden on individuals.

METHOD

This is a descriptive-analytical study carried out on a sample of 614 patients who visited four hospitals in Tehran. The appropriateness or inappropriateness of the MRI prescriptions was determined using clinical guidelines and a questionnaire based on previous studies. The economic burden created by inappropriate prescriptions for MRIs was determined after calculating the total direct and indirect costs.

FINDINGS

The total MRI prescription cost paid by the study sample was $26 071, and the cost of inappropriate prescriptions was $10 310. The MRI prescription rate had a significant relationship with gender, age, education, employment, primary insurance type, and supplemental health insurance.

CONCLUSION

The research findings revealed relatively high rates of inappropriate MRI prescriptions in the private and public sectors. Hence, policymakers should design, create, and develop clinical guidelines and enforce the policies and rules to decrease inappropriate MRI prescriptions.

Does Medical Expansion Improve Population Health?

Medical expansion has become a prominent dynamic in today's societies as the biomedical model becomes increasingly dominant in the explanation of health, illness, and other human problems and behavior. Medical expansion is multidimensional and represented by expansions in three major components of the healthcare system: increasing medical investment, medical professionalization/specialization, and the relative size of the pharmaceutical industry. Using Organisation for Economic Co-operation and Development health data and World Development Indicators 1981 to 2007, we find medical investment and medical professionalization/specialization significantly improve all three measures of life expectancy and decrease mortality rate even after controlling for endogeneity problems. In contrast, an expanded pharmaceutical industry is negatively associated with female life expectancy at age 65 and positively associated with the all-cause mortality rate. It further compromises the beneficial effect of medical professionalization/specialization on population health. In general, medical professionalization/specialization and gross domestic product per capita have similar and stronger effects than medical investment.

Convergence and determinants of health expenditures in OECD countries

This study examines the trend and determinants of health expenditures in OECD countries over the 1975-2004 period. Based on recent developments in the economic growth literature we propose and test the hypothesis that health care expenditures in countries of similar economic development level may converge. We hypothesise that the main drivers for growth in health care costs include: aging population, technological progress and health insurance. The results reveal no evidence that health expenditures among OECD countries converge. Nevertheless, there is evidence of convergence among three sub-groups of countries. We found that the main driver of health expenditure is technological progress. Our results also suggest that health care is a (national) necessity, not a luxury good as some other studies in this field have found.

Investigating Regional Variation of Cardiac Implantable Electrical Device Implant Rates in European Healthcare Systems: What Drives Differences?

Despite established efficacy for cardiac implantable electrical devices (CIEDs), large differences in CIED implant rates have been documented across and within countries. The aim of this paper is to investigate the influence of socio-economic, epidemiological and supply side factors on CIED implant rates across 57 Regions in 5 EU countries and to assess the feasibility of using administrative data for this purpose. A total of 1 330 098 hospitalizations for CIED procedures extracted from hospital discharge databases in Austria, England, Germany, Italy and Slovenia from 2008 to 2012 was used in the analysis. Higher levels of tertiary education among the labour force and percent of aged population are positively associated with implant rates of CIED. Regional per capita GDP and number of implanting centres appear to have no significant effect. Institutional factors are shown to be important for the diffusion of CIED. Wide variation in CIED implant rates across and within five EU countries is undeniable. However, regional factors play a limited part in explaining these differences with few exceptions. Administrative databases are a valuable source of data for investigating the diffusion of medical technologies, while the choice of appropriate modelling strategy is crucial in identifying the drivers for variation across countries. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

Endogenous Technology Adoption and Medical Costs

Despite the claim that technology has been one of the most important drivers of healthcare spending growth over the past decades, technology variables are rarely introduced explicitly in cost equations. Furthermore, technology is often considered exogenous. Using 1996-2007 panel data on Swiss geographical areas, we assessed the impact of technology availability on per capita healthcare spending covered by basic health insurance whilst controlling for the endogeneity of health technology availability variables. Our results suggest that medical research, patent intensity and the density of employees working in the medical device industry are influential factors for the adoption of technology and can be used as instruments for technology availability variables in the cost equation. These results are similar to previous findings: CT and PET scanner adoption is associated with increased healthcare spending, whilst increased availability of percutaneous transluminal coronary angioplasty facilities is associated with reductions in per capita spending. However, our results suggest that the magnitude of these relationships is much greater in absolute value than that suggested by previous studies that did not control for the possible endogeneity of the availability of technologies. Copyright © 2016 John Wiley & Sons, Ltd.