@article{ff428331d11b4ae5ae14ea55633e205b,
title = "Assessing Technological Change in Cardiothoracic Surgery",
abstract = "Technological innovation-broadly defined as the development and introduction of new drugs, devices, and procedures-has played a major role in advancing the field of cardiothoracic surgery. It has generated new forms of care for patients and improved treatment options. Innovation, however, comes at a price. Total national health care expenditures now exceed \$2 trillion per year in the United States and all current estimates indicate that this number will continue to rise. As we continue to seek the most innovative medical treatments for cardiovascular disease, the spiraling cost of these technologies comes to the forefront. In this article, we address 3 challenges in managing the health and economic impact of new and emerging technologies in cardiothoracic surgery: (1) challenges associated with the dynamics of technological growth itself; (2) challenges associated with methods of analysis; and (3) the ways in which value judgments and political factors shape the translation of evidence into policy. We conclude by discussing changes in the analytical, financial, and institutional realms that can improve evidence-based decision-making in cardiac surgery.",
keywords = "clinical trials, cost effectiveness, health policy, technology",
author = "Alexander Iribarne and Russo, \{Mark J.\} and Moskowitz, \{Alan J.\} and Ascheim, \{Deborah D.\} and Brown, \{Lawrence D.\} and Gelijns, \{Annetine C.\}",
note = "Funding Information: Over the past decade, national clinical registries have grown in popularity due to increased attention to outcomes research and quality assurance. The Society of Thoracic Surgeons National Database, established in 1989, serves as one such example. The Society of Thoracic Surgeons database currently captures outcomes from 85\% of the cardiac surgery centers in the US and includes 3.6 million patient records. In addition, the American College of Cardiology with its national cardiovascular data registry contains over 1 million patient records. On a local level, many states, including New York, Massachusetts, and California, require that all centers performing cardiac surgery collect patient data and report outcomes. A unique example of a recently created registry, which is sponsored by Centers for Medicare and Medicaid Services, the US Food and Drug Administration (FDA), and the National Heart, Lung, and Blood Institute, is the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). INTERMACS currently contains data from 88 academic medical centers and over 1500 patients who have received mechanical circulatory support devices (MCSDs). A unique feature of INTERMACS is the ability for continued, longitudinal assessment of MCSDs. As noted previously, during clinical trials a technology will only be studied for a relatively short period on a small, often homogenous study population. Changes in technology may not be captured during the course of a trial drawing into question the future benefits of a particular device or technique. Through INTERMACS, for example, MCSDs can be continuously assessed in an effort to study not only the diffusion of this technology but the patient characteristics that may aid in continued refinement of patient selection. Furthermore, adverse events and survival may be analyzed in relation to patient risk factors, device type, or whether a patient was receiving a device as a bridge to transplant or destination therapy. As the registry is continuously updated, changes in risk factors and outcomes may be monitored over time as technology evolves and clinical decision-making becomes more refined. ",
year = "2009",
month = mar,
doi = "10.1053/j.semtcvs.2009.05.001",
language = "English",
volume = "21",
pages = "28--34",
journal = "Seminars in Thoracic and Cardiovascular Surgery",
issn = "1043-0679",
publisher = "W.B. Saunders",
number = "1",
}