Cost effectiveness of magnetic resonance imaging in the neurosciences.

Szczepura, Ala; Fletcher, Joy; Fitzpatrick, Janet

doi:10.1136/bmj.303.6815.1435

Cited by 30 publications

(7 citation statements)

References 14 publications

(5 reference statements)

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“…Our theory establishes that the HMO enrollment coefficient should be more negative the less profitable the technology. PET, for instance, is such a costly technology that even the Institute for Clinical PET recognizes that for a PET Szczepura et al (1991), Bell (1996), Fletcher et al (1999, Reeve and Baladi (1995), and Evens and Evens (1991 CRR is the quotient between EAC/patient and reimbursement. Annual costs have been computed by the authors using the standard equivalent annual cost (EAC) methodology with a 6% discount rate.…”

Section: Does Managed Care Have the Same Effect On Every Technology?mentioning

confidence: 97%

Is managed care restraining the adoption of technology by hospitals?

Mas¹,

Seinfeld

2008

Journal of Health Economics

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As health care costs increase, cost-control mechanisms become more widespread and it is crucial to understand their implications for the health care market. This paper examines the effect that managed care activity (based on the aim to control health care expenditure) has on the adoption of technologies by hospitals. We use a hazard rate model to investigate whether higher levels of managed care market share are associated with a decrease on medical technology adoption during the period 1982-1995. We analyze annual data on 5390 US hospitals regarding the adoption of 13 different technologies. Our results are threefold: first, we find that managed care has a negative effect on hospitals' technology acquisition for each of the 13 medical technologies in our study, and its effect is stronger for those technologies diffusing in the 1990s, when the managed care sector is at its largest. If managed care enrollment had remained at its 1984 level, there would be 5.3%, 7.3% and 4.1% more hospitals with diagnostic radiology, radiation therapy and cardiac technologies, respectively. Second, we find that the rise in managed care leads to long-term reductions in medical cost growth. Finally, we take into account that profitability analysis is one of the main dimensions considered by hospitals when deciding about the adoption of new technologies. In order to determine whether managed care affects technologies differently if they have a different cost-reimbursement ratio (CRR), we have created a unique data set with information on the cost-reimbursement for each of the 13 technologies and we find that managed care enrollment has a considerably larger negative effect on the adoption of less profitable technologies.

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Section: Does Managed Care Have the Same Effect On Every Technology?mentioning

confidence: 97%

Is managed care restraining the adoption of technology by hospitals?

Mas¹,

Seinfeld

2008

Journal of Health Economics

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“…Historically, most published studies on the clinical efficacy of imaging have focused on technical and diagnostic accuracy. While a few studies have attempted to assess diagnostic and therapeutic impact, 30,[34][35][36][37][38][39][40][41][42] there is little evidence that the use of sophisticated imaging significantly improves patient health or quality of life. 36,39,[42][43][44][45][46] More recently, the evaluative framework has been extended to include a sixth level (impact on society) to include cost-effectiveness 27,32,47 in recognition of the need to evaluate the impact of new technologies on the associated costs to both service users and service providers.…”

Section: Health Technology Assessment Evaluative Hierarchymentioning

confidence: 99%

Does early imaging influence management and improve outcome in patients with low back pain? A pragmatic randomised controlled trial

Gilbert

Grant²,

Gillan³

et al. 2004

Health Technol Assess

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The early use of sophisticated imaging does not appear to affect management overall but does result in a slight improvement in clinical outcome at an estimated cost of 870 British pounds per QALY. Imaging was associated with an increase in clinicians' diagnostic confidence, particularly for non-specialists. Further research is required to determine if more rapid referral to sophisticated imaging and secondary care is important in the acute episode and whether the use of imaging would be more beneficial for particular categories of LBP.

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“…The latter has rarely been applied to the assessment of diagnostic imaging (18) because of perceived issues associated with randomizing patients to a nonimaging policy (27,28). Whereas the within-group design of our study that used before-andafter questionnaires is similar to that used in many other studies (13)(14)(15)(16)19,29), the incorporation of a randomized comparison group has allowed us to control for changes over time that occur whether or not imaging is performed. There were, in fact, marked changes in the control group over time in all aspects of clinical diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 93%

“…Most health technology assessments of imaging (5,8,9) focus on technical and diagnostic performance (8,10,11), with a minority (12)(13)(14)(15)(16)(17)(18)(19)(20) addressing the broader influence of imaging on clinical decision making, patient treatment, and outcome.…”

Section: Resultsmentioning

confidence: 99%