AUSTRALIA’S approach to funding new cardiac devices needs to change if patients are to benefit from rapid strides in technology, according to an editorial published in the 6 August issue of the Medical Journal of Australia.
Innovations such as implantable defibrillators, devices for valvular heart disease, and left ventricular assist devices are fast outpacing our ability to fund them, said Dr David Muller, director of the Cardiac Catheterisation Laboratories at St Vincent’s Hospital in Sydney. (1)
In an environment of limited public funding, he said, cost-effectiveness should be the critical determinant, but instead funding decisions relied on short-term data in selected populations.
“Fundamental to cost-effectiveness analysis is the incremental clinical effectiveness of an intervention and its effect on quality of life”, he wrote.
Dr Muller suggested that true cost-effectiveness and net clinical benefit of new interventions could be better assessed if reliable special-purpose funding was allocated to selected sites across the country.
These sites could then develop expertise, obtain local cost-effectiveness data, and provide follow-up and device surveillance.
A coordinated approach to advanced technology funding would be most efficient and equitable, he wrote.
Dr Muller told MJA InSight that compelling data from the United States, Europe and the United Kingdom showed substantial cost-effectiveness in certain groups of patients. “We’d like to see funding made available for those subgroups here to allow us to collect our own data”, he said.
Professor Derek Chew, a cardiologist at Flinders Medical Centre, agreed that new technologies were being funded without a full understanding of their potential reach and value.
“Health services need to take a strategic forward-looking approach armed with clinical data demonstrating the burden of disease and, based on that, undertake horizon scans for possible technologies that will meet this need and only then invest in prospective evaluations in the field”, he said.
Professor Chew backed Dr Muller’s suggestion that special-purpose centres would provide the best vehicle for this.
“If you want quality outcomes, you need to have experience localised in special centres that communicate with each other.”
He said special-purpose centres could contain costs and maintain quality in the early phase before the technology becomes mainstream.
President of the Cardiac Society of Australia and New Zealand, James Cameron, said a centrally coordinated and funded system was well worth debating.
“Such a system would also need prospective monitoring of process and outcomes through registries, which include performance monitoring along with rapid-response systems to detect early device failure,” Dr Cameron said.
He said the Cardiac Society had an interest in developing such systems for new and available technologies.
Once a technology had gone through the hoop, a guarantee of political support would also be needed, Dr Cameron said.
– Amanda Bryan
Posted 6 August 2012