Technology assessment for the anesthesiologist

The expense associated with modern heath care in the United States is very high, in excess of 15% of the GDP, continues to grow and has become a significant public policy issue. New technologies, defined as all drugs, devices, procedures, and organizational systems, are major contributors to rising health care costs. The use of health technology assessment tools can assist those in leadership positions in making rational decisions as to which new technologies to adopt. The classical approach is to use data from prospective, randomized, clinical trials that compare the outcomes of those treated with the new technology and the accepted therapy. Using this information and detailed economic data, the cost-effectiveness ratio can be determined. The accepted metrics are either dollars per life year saved or dollars per quality-adjusted life year saved. If the new medical intervention costs less than $50,000 to 80,000 dollars per life year saved, it is considered to be cost-effective and worthy of adoption. This kind of analysis is complex and expensive. In addition, the required information is not always available, limiting the applicability of this approach. Finally, the economic analysis often includes down-stream expense and benefit not relevant from a medical center perspective. Another approach is to focus the analysis to what impacts the medical center. This includes determining whether the technology has received the necessary approvals and has been shown to be effective, to improve health outcomes, to be at least as effective as standard therapy, and to be achievable outside the investigative setting. A fiscal analysis also must be done to determine what will it cost to acquire and operate the technology, what are the anticipated patient volumes and payer mix, and what will be the down-stream consequences to the medical center. If the process concludes that the technology works, makes a positive difference to patient care, and is fiscally and operationally acceptable, it should be purchased. After the technology has been installed and has been used, a postimplementation review should be done. This review should go over the same attributes that led to the decision to purchase. It should be determined whether the expected patient volumes, outcomes, income, and expenses were seen. If not, the technology assessment process should be refined to make better decisions in the future. Finally, if the results are at a substantial negative variance from what was anticipated, abandoning the technology should be considered. Anesthesiology either directly controls or indirectly influences a significant portion of medical technology in every medical center. Therefore, the processes that have been discussed in this article should be used by the department of anesthesiology to assure optimal patient care and the fiscal stability of the organization.