Abstract
With the continuous emergence of complex and expensive technologies for use in health care, how do health care managers decide which to support and which to reject. Technology assessment aids in that decision making. The assessment process considers technical characteristics of a new technology, as well as the clinical, economic, and social endpoints (Fuchs and Garber, 1990). Epidemiologic concepts and methods are utilized in technology assessment in determining the safety, clinical efficacy, and cost-effectiveness. Technology assessment can only be adequately performed with a thorough understanding of epidemiologic concepts. Specifically familiarity with study design, measures of effect, and statistical analyses for determining the significance of effect are required to assess a technology. This chapter describes the major components of technology assessment and the use of epidemiologic tools in that process. Case studies at the end of the chapter allow practice in the application of epidemiologic concepts and methods used in performing technology assessment.
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References
American Medical Association, Council on Scientific Affairs, 1988, Application of positron emission tomography in the heart, JAMA 16:2438–2445.
American Medical Association, 1993, Drug Evaluations, AMA, Chicago.
American Society of Hospital Pharmacists, Inc., 1993, American Hospital Formulary Service Drug Information, ASHP, Bethesda, MD.
Anderson, G. F., Hall, M. A., and Steinberg, E. P., 1993, Medical technology assessment and practice guidelines: Their day in court, Am. J. Public Health 83:1635–1639.
Anonymous, 1993, The new queue at the CDRH, In Vivo November:5–9.
Antiplatelet Trialists’ Collaboration, 1988, Secondary prevention of vascular disease by prolonged antiplatelet treatment, Br. Med. J. 296: 320–331.
Appleby, C. R., 1991, HCFA told to cover lenses still in clinical trials, HealthWeek 5 : 4 .
Bailar, J. C., and Mosteller, F., 1988, Guidelines for statistical reporting in articles for medical journals, Ann. Intern. Med. 108:266–273.
Banta, H. D., and Thacker, S. B., 1990, The case for reassessment of health care technology: Once is not enough, JAMA 264:235–240.
Blue Cross and Blue Shield Association, Technology Evaluation Center, 1994, TEC Criteria, The Association, Chicago.
Bootman, J. L., Townsend, R. J., and McGhan, W. E, 1991, Principles of Pharmacoeconomics, Harvey Whitney Books, Cincinnati.
Braitman, L. E., 1991, Confidence intervals assess both clinical significance and statistical significance, Ann. Intern. Med. 114:515–517.
Brown, W. S., and Newman, T. B., 1987, Are all significant p values created equal? The analogy between diagnostic tests and clinical research, JAMA 257:2459–2463.
Calltorp, J., and Smedby, B., 1989, Technology assessment activities in Sweden, Int. J. Technol. Assess. Health Care 5:263–297.
Chalmers, T. C., Smith, H., Jr., Blackburn, B., Silverman, B., Schroeder, B., Reitman, D., and Ambroz, A., 1981, A method for assessing the quality of a randomized control trial, Control. Clin. Trials 2:31–49.
Congress of the United States, Office of Technology Assessment, 1989, Costs and Effectiveness of Screening for Cholesterol in the Elderly, GPO No. 052–003–01151–4, Government Printing Office, Washington, DC.
Congress of the United States, Office of Technology Assessment, 1990, Costs and Effectiveness of Screening for Cervical Cancer in the Elderly, GPO No. 052–003–01176–0, Government Printing Office, Washington, DC.
Davis, K., 1990, Use of data registries to evaluate medical procedures, Int. J. Technol. Assess. Health Care 6:203–210.
Detsky, A. S., 1989, Are clinical trials a cost-effective investment? JAMA 262:1795–1800.
Detsky, A. S., and Naglie, I. G., 1990, A clinician’s guide to cost-effectiveness analysis, Ann. Intern. Med. 113: 147–154.
Diamond, G.A., and Denton, T. A., 1993, Alternative perspectives on the biased foundations of medical technology assessment, Ann. Intern. Med. 118:455–464.
Dickerson, K., and Berlin, J. A., 1992, Meta-analysis: State-of-the-science, Epidemiol. Rev. 14:154–176.
Eddy, D. M., 1989a, Screening for breast cancer, Ann. Intern. Med. 111:389–399.
Eddy, D. M., 1989b, Selecting technologies for assessment, Int. J. Technol. Assess. Health Care 5:485–501.
Ferguson, J. H., Dubinsky, M., and Kirsch, P. J., 1993, Court-ordered reimbursement for unproven medical technology: Circumventing technology assessment, JAMA 269:2116–2121.
Food and Drug Administration, New drug, antibiotic, and biological drug product regulations: Accelerated approval, Federal Register, April 15, 1992, Vol. 57, no. 73, p. 13234.
Fuchs, V. R., and Garber, A. M., 1990, The new technology assessment, N. Engl. J. Med. 323:673–677.
Gelijns, A. C., and Rigter, H., 1990, Health care technology assessment in the Netherlands, Int. J. Technol. Assess. Health Care 6:157–174.
Goodman, C., ed., 1988, Medical Technology Assessment Directory: A Pilot Reference to Organizations, Assessment, and Information Resources, National Academy Press, Washington, DC.
Gross, P. F., 1989, Technology assessment in health care in Australia, Int. J. Technol. Assess. Health Care 5:137–153.
Gruppo Italiano per lo Studio della Sopravivenza nell’ Infarto Miocardico, 1990, GISSI-2: A factorial randomized trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction, Lancet 336:65–71.
[The] GUSTO Investigators, 1993, An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction, N. Engl. J. Med. 329:673–682.
Hatziandreau, E. E., Carlson, K., Mulley, A. G., and Weinstein, M. C., 1990, Cost-effectiveness study of the extracorporeal shock-wave lithotripter, Int. J Technol. Assess. Health Care 6:623–632.
Hooper, D. C., and Wolfson, J. S., 1991, Fluoroquinolone antimicrobial agents, N. Engl. J. Med. 324:384–394.
Institute of Medicine, Council on Health Care Technology, 1990, National Priorities for the Clinical Conditions and Medical Technologies, Report of a Pilot Study, National Academy Press, Washington, DC.
[The] Ischemic Optic Neuropathy Decompression Trial Research Group, 1993, OpterVe decompression surgery for nonarteritic anterior ischemic optic neuropathy (NAION) is not effective and may be harmful, JAMA 273: 625–632.
ISIS-3 Collaborative Group, 1992, ISIS-3: A randomized comparison of streptokinase vs. tissue plasminogen activator vs. anistreplase and of aspirin plus heparin vs. aspirin alone among 41,299 cases of suspected acute myocardial infarction, Lancet 339:753–770.
Jordan, A. M., 1991, Hospital charges for laparoscopic and open cholecystectomy, JAMA 266:3425–3426.
Koch, P. W., 1987, Government reimbursement policy and medical technology assessment: The case of Switzerland, Int. J. Technol. Assess. Health Care 3: 607–612.
Larson, E. B., and Kent, D. L., 1989, The relevance of socioeconomic and health policy issues to clinical research, Int. J. Technol. Assess. Health Care 5:195–206.
Laupacis, A. L., Sackett, D. L., and Roberts, R. S., 1988, An assessment of clinically useful measures of the consequence of treatment, N. Engl. J. Med. 318:1728–1733.
Leape, L., 1989, Unnecessary surgery, Health Serv. Res. 23:351–407.
LeGales, C., and Moatt, J. P., 1990, Searching for consensus through multicriteria decision analysis: Assessment of screening strategies for hemoglobinopathies in southeastern France, Int. J. Technol. Assess. Health Care 6: 430–449.
Luce, B. R., 1990, The risk manager’s role in cost-effectiveness studies of new technology, Perspect. Healthcare Risk Manage. Spring:13–16.
Lumsdon, K., 1991, Biotechnology drugs create new maze of concerns for hospitals, Hospitals December:32–35.
MacDonald, D., Grant, A., Sheridan-Pereira, M., Boylan, P., and Chalmers, I., 1985, The Dublin randomized controlled trial of intrapartum fetal heart rate monitoring, Am. J. Obstet. Gynecol. 152:524–539.
Maloney, J. V., 1988, Technology in health care: The social impact and economic cost, Med. Prog. Technol. 14:109–114.
Matuszewski, K., and Vermeulen, L., 1994, Medical technology assessment, Critical Issues Shaping MedicalPractice, University Hospital Consortium, Oakbrook, IL.
McGivney, W. T., and Hendee, W. R., 1988, Technology assessment in medicine: The role of the American Medical Association, Arch. Pathol. Lab. Med. 112 :1181–1185.
McGivney, W. T., and Hendee, W. R., 1990, Regulation, coverage, and reimbursement of medical technologies, Int. J. Radial. Oncol. Biol. Phys. 18: 697–700, 1990.
Murphy, J. R., 1991, The assessment process: A microscopic view, Med. Prog. Technol. 17(2):77–83.
National Center for Health Statistics, 1990, 1989 Hospital Discharge Survey, NCHS, Hyattsville, MD.
National Center for Health Statistics, 1993, Rates of cesarean delivery—United States, 1991, Morbid. Mortal. Weekly Rep. 42 :285–289.
National Institutes of Health, 1990, Intravenous Immunoglobulin:Consensus Statement 8,no 5, NIH, Bethesda, MD.
Naylor, C. D., Chen, E., and Strauss, B., 1992, Measured enthusiasm: Does the method of reporting trial results alter perception of therapeutic effectiveness? Ann. Intern. Med. 117:916–921.
Office of Technology Assessment, 1976, Development of Medical Technology: Opportunities for Assessment, U.S. Government Printing Office, Washington, DC.
Ozminkowski, R. J., Wortman, P., and Roloff, D., 1987, Evaluating the effectiveness of neonatal intensive care: What can the literature tell us? Am. J. Perinatol. 4:339–347.
Park, R. E., Fink, A., Brook, R. H., Chassin, M. R., Kahn, K. L., Merrick, N. J., Kosecoff, J., and Solomon, D. H., 1986, Physician ratings of appropriate indications for six medical and surgical procedures, Am. J. Public Health 76:766–772.
Perry, S., Hanft, R., and Chrzanowski, R., 1991, Technology assessment reports, Int. J. Technol. Assess. Health Care 7:68–105.
Radensky, P., 1991, Federal activities related to health and economic outcomes, Administrative Radiology 54:53–55.
Raskin, I. E., and Maklan, C. W., 1991, Medical treatment effectiveness research: A view from the inside the agency for health care policy and research, Eval. Health Prof. 14(2):161–186.
Rimm, A. A., Barr, J. T., Horowitz, M. M., and Bortin, M. M., 1991, Use of a clinical data registry to evaluate medical technologies, Int. J. Technol. Assess. Health Care 7:182–193.
Ronning, P. L., 1994, The impact of health care reform on technology, ECRI’s Hosp. Technol. Scanner January:5–8.
Schaffarzick, R. W., 1987, Health care technology and quality of care, Am. Coll. Util. Rev. Physicians 2:84–89.
Schecter, M. T., and Bimbaum, D., 1989, Technology assessment, J. Healthcare Mater. Manage. Nov/Dec:66–72.
Schwartz, J. S., and Lurie, N., 1990, Assessment of medical outcomes: New opportunities for achieving a long sought-after objective, Int. J. Technol. Assess. Health Care 6:333–339.
Schwartz, W. B., 1987, The inevitable failure of current cost-containment strategies, JAMA 257:220–224.
Shy, K. K., Luthy, D. A., Bennett, E C., Whitfield, M., Larson, E. B., van Belle, G., Hughes, J. P., Wilson, J. A., and Stenchever, M. A., 1990, Effects of electronic fetal heart rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants, N. Engl. J. Med. 322:588–593.
Steinbrook, R., and Lo, B., 1990, Informing physicians about promising new treatments for severe illness, JAMA 263:2078–2082, 1990.
Stocking, B., and Jennett, B., 1984, Consensus development conference—coronary artery bypass surgery in Britain, British Medical Journal of Clinical Research 288:1712.
Stocking, B., 1988, Medical technology in the United Kingdom, Int. J. Technol. Assess. Health Care 4:171–183.
Sugarman, S. D., 1990, The need to reform personal injury law leaving scientific disputes to scientists, Science 248:823–827.
Sussman, J. H., 1991, Financial considerations in technology assessment, Top. Health Care Financ. 17:30–41.
Thompson, W. D., 1987, Statistical criteria in the interpretation of epidemiologic data, Am. J. Public Health 77: 191–194.
Turner, D. A., Alcorn, F., Shorey, W. D., Stelling, C. B., Mategrano, V., Merten, C. W., Silver, B., Economou, S. G., Straus, A. K., Witt, T. R., and Norusis, M., 1988, Carcinoma of the breast: Detection with MR imaging versus xeromammography, Radiology 168:49–59.
Udvarhelyi, I. S., Colditz, G. A., Rai, A., and Epstein, A. M., 1992, Cost-effectiveness and cost¨Cbenefit analyses in the medical literature: Are the methods being used correctly? Ann. Intern. Med. 116:238–244.
United States Pharmacopoeial Convention, Inc., 1993, Drug Information for the Health Care Professional, Rockville, MD, 1993.
USDHHS, NIH, 1981, Cesarean Childbirth: Report of the NICHD Task Force on Cesarean Childbirth, NIH Pub. No. 82–2067, DHHS, Bethesda, MD.
USDHHS, PHS, Agency for Health Care Policy Research, 1990a, AHCPR Program Note, DHHS, Rockville, MD.
USDHHS, PHS, Agency for Health Care Policy Research, 1990b, Health Technology Assessment Reports: Abstract of Office of Health Technology Reports, 1988–1989, DHHS Pub. No (PHS)90–3459, Rockville, MD.
USDHHS, PHS, National Cancer Institute, 1991a, Cancer Statistics Review 1973–1988, NIH Pub. No. 91–2789, Bethesda, MA.
USDHHS, PHS, Agency for Health Care Policy Research, 1991b, Health Technology Assessment Report: Carotid Endarterectomy, DHHS Pub. no. (PHS)91–0029, Rockville, MD.
USDHHS, PHS, Agency for Health Care Policy Research, 1994, Health Technology Assessment. Institutional and Patient Criteria for Heart¨CLung Transplantation, AHCPR Pub. No. 94–0042, Rockville, MD.
Veluchamy, S., and Saver, C. L., 1990, Clinical technology assessment, cost-effectiveness adoption, and quality management by hospitals in the 1990s, Quality Rev. Bull. 16:223–228.
Vermeulen, L. C., Matuszewski, K. A., Ratko, T. A., Burnett, D. A., and Vlasses, P. H., 1994, Evaluation of ondansetron prescribing in U.S. academic medical centers, Arch. Intern. Med. 154:1733–1740.
Vermeulen, L. C., Ratko, T. A., Erstad, B. L., Brecher, M. E., and Matuszewski, K. A., 1995, A paradigm for consensus: The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions, Arch. Int. Med. 155:373–379.
Wagner, M., 1991, Outcome research affecting devices, Mod. Healthcare February:54.
Ware, J. E., and Sherbourne, C. D., 1992, The MOS 36-item short-form health survey (SF-36), Med. Care 30: 473–483.
Weill, C., Fagnani, F., and LeFaure, C., 1989, The assessment of medical technology: The case of France, Mt. J. Technol. Assess. Health Care 5:144–150.
Wortman, P., and Yeaton, W. H., 1985, Cumulating quality of life results in controlled trials of coronary artery bypass graft surgery, Controlled Clinical Trials 6:289–305.
Yim, J. M., Matuszewski, K. A., Vermeulen, L. C., Ratko, T. A., Burnett, D. A., and Vlasses, P. H., 1995, Surveillance of colony-stimulating factor use in U.S. academic health centers, Ann. Pharmacotherapy (in press).
Young, F. E., 1988, Paying for Progress: Reimbursement and Regulated Medical Products, Presented to the Blue Cross and Blue Shield Technology Management Conference, Chicago, November.
Yusuf, S., Peto, R., Lewis, J., Collins, R., and Sleight, P., 1985, Beta blockade during and after myocardial infarction: An overview of the randomized trials, Prog. Cardiovasc. Dis. 27:335–371.
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Matuszewski, K.A. (1995). Technology Assessment. In: Oleske, D.M. (eds) Epidemiology and the Delivery of Health Care Services. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-1839-6_7
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DOI: https://doi.org/10.1007/978-1-4615-1839-6_7
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