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October 14, 2009
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Sue Ducat

Two Health Affairs Studies Question The Cost Benefits Of Some Medical Technologies

Bethesda, MD - High technology medical devices can perform miracles but usually command a high price – for the hospitals that buy them and the consumers who use them. Health Affairs today released two studies which shed light on some of the financial and medical consequences when hospitals acquire the latest equipment.

Adoption And Spread Of New Imaging Technology: A Case Study
By Joseph A. Ladapo, Jill R. Horwitz, Milton C. Weinstein, G. Scott Gazelle, and David M. Cutler

Author affiliations:
Ladapo -- Beth Israel Deaconess Medical Center (Boston)
Horowitz -- University of Michigan Law School
Weinstein -- Harvard School of Public Health
Gazelle -- Harvard Medical School
Cutler -- Harvard University

Ever higher resolution in CT (computed tomography) promises physicians and patients faster, more accurate diagnoses for heart disease. Authors studied the rapid adoption of the latest CT scan equipment and asked what happens when a hospital acquires this multimillion dollar piece of equipment? For this case study about a technological innovation with unverified benefits with wide usage, the authors chose the 64-slice CT, first introduced in 2004, because many hospitals are acquiring it for the care of their cardiac patients. Many practitioners use the 64-slice CT because of its superior coronary CT angiography capabilities. The authors collected data to understand the financial and therapeutic motivations that drove hospitals to acquire this technology. (Despite its cost of$1.5-$2.0 million, almost 30% of non-rural general hospitals owned this equipment by 2006.) While they found that "the likelihood of adopting 64-slice CT by 2006 increased with the total number of ischemic heart disease patients a hospital admitted," they also noted that "the relationship between adoption and operating margins imply that hospitals may make acquisition decisions irrespective of clinical need." Funding for this study was provided through the Walker Fund of the Harvard Ph.D. Program in Health Policy; the Program on Law, Economics, and Technology at the University of Michigan (supported by a grant from Microsoft); and the National Institute on Aging.

Magnetic Resonance Imaging And Low Back Pain Care For Medicare Patients
By Jacqueline D. Baras and Laurence C. Baker of Stanford University
Both authors are affiliated with Stanford University

The magnetic resonance imaging (MRI) scanner, with a $2 million price tag, is frequently used to evaluate low back pain, the fifth-most common reason people visited the doctor in the U.S. in 2002. The number of MRI scanners in the U.S. dramatically expanded between 2000 and 2005. To determine how MRI technology influences patient treatment, the authors collected data on traditional Medicare patients from each of the 318 Metropolitan Statistical Areas in the U.S. who had received care for nonspecific low-back pain from 1998 to 2005. They found that areas with the largest growth in MRI machines also had the largest growth in low back MRIs billed to Medicare. Over one-half of the MRI scans that resulted from increased availability were received within the first month of low back pain onset. "Not only are patients in high-availability areas getting more MRIs, but they are getting them earlier," said Ms. Baras. "This is worrisome because since 1994 clinical guidelines have recommended delaying MRI use, as most new onset low back pain will improve within four weeks." The authors also found that high local MRI availability was correlated with increased rates of low-back surgery. Since previous studies have not demonstrated clear benefit of surgery in patients with nonspecific low back pain, the authors concluded that this finding has troubling implications. Said Ms. Baras, "It is important that policymakers recognize that infrastructure matters, and that the number of MRI machines in any particular area may affect the volume and quality of health care that patients receive." This study was funded by the Stanford University School of Medicine and the California HealthCare Foundation.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


©2009 Project HOPE–The People-to-People Health Foundation, Inc.