Faith is no substitute for data

October 23, 2009

I grew up believing that you get what you pay for. Look for sales, not knockoffs. Buy inexpensive, not cheap. Those were my shopping tenets, handed down by parents who lived through the Great Depression. After many years of believing this, I’m sorry to say the tenets may not actually hold, at least not in medicine.

I grew up believing that you get what you pay for. Look for sales, not knockoffs. Buy inexpensive, not cheap. Those were my shopping tenets, handed down by parents who lived through the Great Depression. After many years of believing this, I’m sorry to say the tenets may not actually hold, at least not in medicine.

An analysis by researchers at the University of Michigan Comprehensive Cancer Center shows that costs vary widely for different treatment regimens and from one method of delivering radiation to the next. Yet receiving more treatments and spending extra on more sophisticated technology may do little for cancer patients, at least when it comes to pain relief.

Radiation treatments can help relieve pain of cancer that’s spread to the bone. A single treatment with conventional techniques costs around $1700. Patients may receive multiple treatments. Yet research has shown a single treatment can be just as effective as 10 treatments. Keeping the number of treatments low also spares patients and their caregivers trips to the treatment center and reduces patients’ radiation burden. The same disconnect between money spent and results is seen when comparing conventional with advanced equipment to deliver this radiation.

“Some of the technologies that have been shown to be safe and effective, but have not been shown to be superior, can cost up to 10 times what a single dose of conventionally delivered radiation costs,” said Dr. David D. Howell, an assistant professor of radiation oncology at the University of Michigan.

Costs can reach more than $16,000 for four treatments using a stereotactic radiosurgical device such as the Cyberknife. If they have proven no better, why, then, do some doctors use the more expensive methods? Possibly because they believe more recently developed technologies yield better pain control or fewer side effects in the long term for certain patients, Howell said.

This kind of faith in advanced technology is not peculiar to radiation oncology. The use of MRI took off in the 1980s long before studies determined unequivocally that its images were actually showing disease processes that could affect patient management. The same goes for the adoption of advanced technologies in virtually any imaging modality, from ultrasound to nuclear medicine, CT to mammography. It’s easy to conclude that clearer pictures of smaller structures and anomalies are better-but the proof can be a long time coming.

With medical costs under increased scrutiny, gut feeling about the benefits of an advanced medical technology are hard to justify. This underscores the need for clinical research as an integral part of R&D, research that might not only provide guidance for the use of new equipment, but in its development ensure that providers get the biggest bang for their buck.

Some vendors have begun documenting technical specifications of their equipment in applications sent to the FDA for review. More is needed, however, to make the leap to clinical benefit early in devices’ and techniques’ development process.