The cover story of Minnesota Medicine is “The Medical Arms race: how many high-priced robots and scanners can we afford?”
Excerpt: “How many children’s hospitals, heart centers, bariatric centers, robotic surgery systems, PET scanners, MRI scanners, and so on does a given population area need to serve its genuine health care requirements, as opposed to the maximum convenience of patients or the economic interests of physicians and hospitals?
Former U.S. Sen. David Durenberger, chair of the National Institute of Health Policy (NIHP) at the University of St. Thomas in Minneapolis, is one of the more vocal critics. …
As an example, he points to the CyberKnife, a radiosurgery system that enables treatment of intracranial and extracranial tumors previously considered inoperable. According to news reports, a CyberKnife lists for more than $3.5 million. In 2003, St. Joseph’s Hospital in St. Paul was the only center in the Upper Midwest that had one. Now there is another CyberKnife at Miller-Dwan Hospital in Duluth. ‘Where did all the extra patients come from?’ Durenberger asks. ‘Was there a long waiting line at St. Joseph’s? I suspect not.’
Another case in point: the da Vinci robot, a $1 million-plus system used for laparoscopic surgeries such as gallbladder removals, prostatectomies, and bariatric surgery. In 2004, three Minnesota hospitals (the University of Minnesota Medical Center, HealthEast St. John’s, and Mayo Clinic in Rochester) had da Vinci systems. By 2006, the robots were in six hospitals, including facilities in Duluth and St. Cloud, according to manufacturer Intuitive Surgical Systems of Sunnyvale, California. Surgeons report a number of benefits these systems provide, such as an improved view of the surgical field and the elimination of tremor in movement. But a study of the 202 initial robotic abdominal surgery cases performed at Johns Hopkins University Hospital in Baltimore found that ‘clinical data demonstrating improved [patient] outcomes are lacking.’
The concern is that the proliferation of CyberKnifes and da Vincis and free-standing $2-million MRI scanners and $1-million CT scanners may be driven less by patient need than by market share or providers’ desire to use the latest technology to attract specialists who do procedures that pay well: gastroenterologists, cardiologists, and neurosurgeons, for example. A claim on the Web site of Sunnyvale, California-based Accuray, CyberKnife’s maker, is that buyers say the device ‘attracts new patients and increases their practice volumes.’
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But the issue of cost-effectiveness is nowhere addressed, he says.
‘In any other industry,’ Durenberger says, ‘when someone invents something new, market mechanisms determine whether it catches on and to what extent.’ For instance, if someone invents a video game, ‘there is a market that tells you this is something that X number of people want and are willing to pay X dollars for. That analogy applies practically everywhere except in health care.’ “