{"id":433,"date":"2010-04-27T12:53:00","date_gmt":"2010-04-27T16:53:00","guid":{"rendered":"http:\/\/blog.cmhughesmd.com\/?p=433"},"modified":"2010-04-27T12:53:00","modified_gmt":"2010-04-27T16:53:00","slug":"much-cheaper-almost-as-good-decrementally-cost-effective-medical-innovation-ann-intern-med","status":"publish","type":"post","link":"http:\/\/blog.cmhughesmd.com\/?p=433","title":{"rendered":"Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation \u2014 Ann Intern Med"},"content":{"rendered":"<p><a href=\"http:\/\/annals.org\/content\/151\/9\/662.full?sid=ef4b4484-7951-46b1-9e84-9a2e48df8a75\">Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation \u2014 Ann Intern Med<\/a><\/p>\n<blockquote><p>Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options, by permitting more efficient reallocation of resources. The authors systematically reviewed all MEDLINE-cited cost\u2013utility analyses written in English from 2002 to 2007 to identify and describe cost- and quality-decreasing medical innovations that might offer favorable \u201cdecrementally\u201d cost-effective tradeoffs\u2014defined as saving at least $100 000 per quality-adjusted life-year lost. Of 2128 cost-effectiveness ratios from 887 publications, only 9 comparisons (0.4% of total) described 8 innovations that were deemed to be decrementally cost-effective. Examples included percutaneous coronary intervention (instead of coronary artery bypass graft) for multivessel coronary disease, repetitive transcranial magnetic stimulation (instead of electroconvulsive therapy) for drug-resistant major depression, watchful waiting for inguinal hernias, and hemodialyzer sterilization and reuse. On a per-patient basis, these innovations yielded savings from $122 to almost $12 000 but losses of 0.001 to 0.021 quality-adjusted life-years (approximately 8 hours to 1 week). These findings demonstrate the rarity of decrementally cost-effective innovations in the medical literature. <\/p><\/blockquote>\n<p>From Drs. Nelson, Cohen, Greenburg and Kent in Annals of Internal Medicine.<\/p>\n<p>Interesting article explicitly making the argument for more research to figure out where we reach diminshing marginal returns in specific treatments for specific conditions.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation \u2014 Ann Intern Med Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less &hellip; <a href=\"http:\/\/blog.cmhughesmd.com\/?p=433\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation \u2014 Ann Intern Med&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"sfsi_plus_gutenberg_text_before_share":"","sfsi_plus_gutenberg_show_text_before_share":"","sfsi_plus_gutenberg_icon_type":"","sfsi_plus_gutenberg_icon_alignemt":"","sfsi_plus_gutenburg_max_per_row":"","footnotes":""},"categories":[41],"tags":[],"class_list":["post-433","post","type-post","status-publish","format-standard","hentry","category-efficiency-in-health-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts\/433","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=433"}],"version-history":[{"count":0,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=\/wp\/v2\/posts\/433\/revisions"}],"wp:attachment":[{"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=433"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=433"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.cmhughesmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=433"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}