Washington Scrutinizes Medical Technology

E-Newsletter #57, October 14, 2010

People covered by Washington state’s health care plans—public employees and retirees, and the state Medicaid and workers’ compensation programs—had five options to test for colon cancer.

The question was this: Was adding another option necessary?

A CT or virtual colonoscopy was a new technology that doctors in the state wanted to use. But for it to be an approved option, it had to gain approval from the state’s Health Technology Assessment Program.

“A lot of variability in cost drivers are often in new technologies,” said Leah Hole-Curry, program director. “Some of them are very useful and helpful and we need to find those and pay for them, but some of them aren’t any better than what we’re doing today.”

The Health Technology Assessment Program—one of eight state programs nationwide to win a Council of State Governments Innovations Award—convenes a committee of 11 clinicians from around the state each quarter to consider and evaluate new medical technologies.

“The main purpose (of the program) is to get reliable, unbiased clinical information to make better health choices,” Hole-Curry said.

The clinical committee first considers safety and effectiveness then looks at cost.

For that CT colonoscopy, the clinical committee found the new test was about equivalent in safety. The traditional colonoscopy had more risk of colon perforation, but the CT colonoscopy had radiation risks, Hole-Curry said. The next question dealt with effectiveness: Did the evidence show CT colonoscopy was able to reduce cancer mortality rates?

“You can presume that catching it at an earlier stage would be beneficial,” Hole-Curry said.

That’s when the cost factor came into play. Because the new technology had the same risk and effectiveness as other approved options, the cost of the CT colonoscopy—at $900, it costs about $150 more than the optical scan, and must be performed twice as often—could not be justified, Hole-Curry said.

The committee has approved about half of the technologies it’s considered since the program began in 2007, according to Hole-Curry. Those technologies that aren’t approved are re-reviewed in 18 months, she said.

If, for instance, the CT colonoscopy can be offered at a comparable price—if it’s equivalent to other cancer screening options on safety and efficacy—the committee would likely approve it at that re-review point, she said.

“Most of the ones that aren’t approved, it’s not because they’re found to be unsafe,” she said. It’s that there isn’t enough evidence yet to prove it’s safe or effective.

Legislation establishing the Health Technology Assessment Program was unanimously approved, according to Hole-Curry. Hospital and medical associations in the state, as well as industry lobbyists, supported the concept. All seem to like having an external committee of practicing clinicians making recommendations based on good solid evidence.

“It helps us set aside some of the acrimony that you usually would see in a program like this of governments or bureaucrats making health care decisions,” she said.

Hole-Curry calls that clinical group the key to the success of the program. Doctors know it’s their colleagues setting criteria on the tests.

“It takes some of the ‘us versus them’ out of the communication, which is really important,” she said.

Hole-Curry said other states can adopt a similar model that would cut health care costs—but that shouldn’t be the motivator.

“This is not a program to only find the cheapest, but it does apply a fair, rigorous evaluation to find the best quality,” she said. “Using evidence to find tests and treatments that are safe and work—and provide good value—will improve quality by focusing our limited state dollars on the most effective care.”

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