On the New York Times’ online opinion page, Dr. Zeke Emanuel wrote, “In Medicine, Falling for Fake Innovation.” Excerpt:
“The sleek, four-armed “da Vinci” robot has been called a breakthrough technology for procedures like prostate surgery. “Imagine,” the manufacturer says, “having the benefits of a definitive treatment but with the potential for significantly less pain, a shorter hospital stay, faster return to normal daily activities.”
That’s just the kind of impressive-sounding innovation that critics of the health care reform act say will be stifled by the new law, with its emphasis on cost control and the comparative effectiveness of new pills and devices. “Instead of encouraging innovation,” wrote Senator Ron Johnson, Republican of Wisconsin, in The Wall Street Journal, “it stifles creativity.”
The critics are right — if they’re talking about innovations like the da Vinci robot, which costs more than a million dollars and yet has never been shown by a randomized trial to improve the outcomes of prostate surgery. Indeed, a 2009 study showed that while patients had shorter hospital stays and fewer surgical complications like blood loss when they underwent this kind of robotic surgery, they later “experienced more … incontinence and erectile dysfunction.” Similar problems are occurring with robotic surgery for other cancers.
In other words, this is a pseudo-innovation — a technology that increases costs without improving patients’ health.”
Recently, MedPageToday reported on a paper presented at the American Urological Association annual meeting:
“Robotic-assisted radical prostatectomy (RARP) cost 60% more than an open procedure, a difference driven primarily by higher operating-room costs, according to data from one large medical center.
On average, robotic procedures cost $6,000 more than open procedures, and the hospital lost approximately $4,000 on each robotic procedure.
The robotic technique accounted for 60% of the total cost of each RARP, Jeffrey Tomaszewski, MD, reported here at the American Urological Association meeting.
“We asked our finance department to see how many more robotic procedures we would have to make a difference [in the disparity], and we would almost have to increase our volume by a factor of 10 just to break even,” said Tomaszewski, of the University of Pittsburgh.
Radical prostatectomy accounts for about half of all costs associated with treating prostate cancer, currently estimated at $1.7 billion annually. Use of RARP has increased rapidly since its introduction and has become the predominant technique for prostate removal (J Urol 2012:187:1392-1398).
RARP volume has grown in the absence of data to demonstrate the cost-effectiveness of the surgery, said Tomaszewski.
“Given that medical devices are not subject to the same level of scrutiny, compared to pharmaceuticals, in demonstrating clinical effectiveness, the rapid adoption of new medical technologies significantly contributes to spiraling healthcare costs,” he added.”