A Framework for Assessing the Value of Diagnostic Imaging in the Era of Comparative Effectiveness Research

Published Online:https://doi.org/10.1148/radiol.11110155

The key challenge for the imaging community is to develop methods and processes for developing and using outcomes data in a manner that is consistent, transparent, participatory, and fair, and that addresses the unique features of the technology.

In June 2009, the Federal Coordinating Council for Comparative Effectiveness Research submitted a report to the President and Congress in which the Council described the purpose of comparative effectiveness research (CER) as developing evidence-based information for interventions and determining under what circumstances an intervention is effective (1). With the enactment of the Patient Protection and Affordable Care Act, a Patient-centered Outcomes Research Institute (PCORI) was established to assist decision makers in making evidence-based health decisions through synthesis and dissemination of clinical CER of health interventions (2). Its founding has underscored a heightened need for health policy makers to consider the impact of health care technologies on final outcomes of interest—for example, functional status, quality of life, disability, major clinical events, and mortality (35).

© RSNA, 2011

References

  • 1 Federal Coordinating Council for Comparative Effectiveness Research. Report to the President and Congress. U.S. Department of Health and Human Services. http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf. Published 2009. Accessed March 31, 2010.
  • 2 Association of American Medical Colleges. Summary of Patient-Centered Outcomes Research Provisions. Association of American Medical Colleges. https://www.aamc.org/download/131994/data/pcorsummary04022010.pdf. Published 2010. Accessed September 13, 2010.
  • 3 Neumann PJ, Weinstein MC. Legislating against use of cost-effectiveness information. N Engl J Med 2010;363(16):1495–1497.
  • 4 Chambers JD, Neumann PJ. US healthcare reform: implications for health economics and outcomes research. Expert Rev Pharmacoecon Outcomes Res 2010;10(3):215–216.
  • 5 Neumann PJ, Tunis SR. Medicare and medical technology—the growing demand for relevant outcomes. N Engl J Med 2010;362(5):377–379.
  • 6 Fineberg HV. Evaluation of computed tomography: achievement and challenge. AJR Am J Roentgenol 1978;131(1):1–4.
  • 7 Fineberg HV, Bauman R, Sosman M. Computerized cranial tomography. Effect on diagnostic and therapeutic plans. JAMA 1977;238(3):224–227.
  • 8 Fryback DG, Thornbury JR. The efficacy of diagnostic imaging. Med Decis Making 1991;11(2):88–94.
  • 9 Lijmer JG, Leeflang M, Bossuyt PM. Proposals for a phased evaluation of medical tests. Med Decis Making 2009;29(5):E13–E21.
  • 10 Pearson SD, Knudsen AB, Scherer RW, Weissberg J, Gazelle GS. Assessing the comparative effectiveness of a diagnostic technology: CT colonography. Health Aff (Millwood) 2008;27(6):1503–1514.
  • 11 Hollingworth W, Jarvik JG. Technology assessment in radiology: putting the evidence in evidence-based radiology. Radiology 2007;244(1):31–38.
  • 12 Lee DW, Neumann PJ, Rizzo JA. Understanding the medical and nonmedical value of diagnostic testing. Value Health 2010;13(2):310–314.
  • 13 Fuchs VR, Garber AM. The new technology assessment. N Engl J Med 1990;323(10):673–677.
  • 14 Bresnahan BW. Economic evaluation in radiology: reviewing the literature and examples in oncology. Acad Radiol 2010;17(9):1090–1095.
  • 15 Drummond M, Griffin A, Tarricone R. Economic evaluation for devices and drugs—same or different? Value Health 2009;12(4):402–404.
  • 16 Chambers JD, Neumann PJ, Buxton MJ. Does Medicare have an implicit cost-effectiveness threshold? Med Decis Making 2010;30(4):E14–E27.
  • 17 Mauskopf JA, Sullivan SD, Annemans L, et al.. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices—budget impact analysis. Value Health 2007;10(5):336–347.
  • 18 International Early Lung Cancer Action Program InvestigatorsHenschke CI, Yankelevitz DF, et al.. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355(17):1763–1771.
  • 19 Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB. Computed tomography screening and lung cancer outcomes. JAMA 2007;297(9):953–961.
  • 20 National Cancer Institute. Lung cancer trial results show mortality benefit with low-dose CT: Twenty percent fewer lung cancer deaths seen among those who were screened with low-dose spiral CT than with chest X-ray. National Cancer Institute. http://www.cancer.gov/newscenter/pressreleases/NLSTresultsRelease. Published 2010. Accessed November 30, 2010.
  • 21 Neumann PJ. Using cost-effectiveness analysis to improve health care: opportunities and barriers. New York, NY: Oxford University Press, 2005.
  • 22 Mitka M. Colorectal cancer screening rates still fall far short of recommended levels. JAMA 2008;299(6):622.
  • 23 Pickhardt PJ, Hassan C, Laghi A, Kim DH. CT colonography to screen for colorectal cancer and aortic aneurysm in the Medicare population: cost-effectiveness analysis. AJR Am J Roentgenol 2009;192(5):1332–1340.
  • 24 Knudsen AB, Lansdorp-Vogelaar I, Rutter CM, et al.. Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the medicare population. J Natl Cancer Inst 2010;102(16):1238–1252.
  • 25 Centers for Medicare and Medicaid Services. Decision memo for screening computed tomographic colonography (CTC) for colorectal cancer (CAG-00396N). Centers for Medicare and Medicaid Services. http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=220&. Published 2009. Accessed July 27, 2010.
  • 26 Dhruva SS, Phurrough SE, Salive ME, Redberg RF. CMS’s landmark decision on CT colonography—examining the relevant data. N Engl J Med 2009;360(26):2699–2701.
  • 27 Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59(4):225–249.
  • 28 Centers for Medicare and Medicaid Services. Decision memo for positron emission tomography (FDG) for cervical cancer (CAG-00181R2). Centers for Medicare and Medicaid Services. http://www.cms.gov/mcd/viewnca.asp?from=basket&where=&what=&nca_id=232&basket=nca:00181R2:232:Positron+Emission+Tomography+%28FDG%29+for+Cervical+Cancer:Closed:2nd+Recon:13. Published 2009. Accessed July 28, 2010.
  • 29 Schwarz JK, Grigsby PW, Dehdashti F, Delbeke D. The role of 18F-FDG PET in assessing therapy response in cancer of the cervix and ovaries. J Nucl Med 2009;50(Suppl 1):64S–73S.

Article History

Received February 3, 2011; revision requested March 11; revision received May 26; accepted June 17; final version accepted August 2. Supported by GE Healthcare.
Published online: Dec 2011
Published in print: Dec 2011