COMPARATIVE EFFECTIVENESS OF CARDIOVASCULAR DEVICES AND MEDICARE COST GROWTH

描述（由申请人提供）：要完全了解新医疗技术在改善人口医疗保健结果方面的比较有效性，必须完全阐明新技术如何增加国家医疗保健成本。卫生经济学家普遍认为，新技术是美国医疗保健成本上升的主要驱动力，但新技术导致成本增长的确切机制尚不确定。同样不确定的是，当地医疗保健市场因素如何影响新技术带来的成本增加。最后，目前还不清楚国家政策措施，如医疗保险的覆盖与证据发展计划，诊断相关组（DRG）分配的变化，以及DRG报销率的修改如何影响医疗保险费用的增长率。植入式心血管装置是医疗保险计划覆盖的最昂贵的治疗方法之一，最近医疗保险和医疗补助服务中心对药物洗脱冠状动脉支架（2003年）和颈动脉支架（2004年）的覆盖决定，以及对植入式心律转复器覆盖适应症的扩展（2003年和2005年），可能需要数十亿美元的额外年度支出的医疗保险计划。因此，更清楚地了解这些设备引入临床实践如何影响医疗保险成本增长，可以为未来医疗保险支出的预测提供重要信息，从而为这些新技术（以及类似的未来创新）相对于成本的相对有效性提供决策信息。在本项目中，我们将分析2001- 2008年的国家医疗保险索赔数据，以实现以下目标：（1）衡量这3种新的心血管技术增加医疗保险支出的程度，并评估可归因于技术直接成本增加、护理量扩大的成本增长比例，接受治疗的患者的特征发生变化，补充性医疗保健支出增加，下游成本发生变化;（2）为了确定这3种心血管新技术的成本增长在小的地理区域内的变化情况，并评估技术相关成本增长中归因于市场层面因素（例如医院竞争强度）的比例，医疗保健市场中是否存在心脏专科医院，或者是否存在参与器械临床试验的医院;以及（3）探讨医疗保险覆盖范围决定和政策中关于这三种技术的差异，包括不同的机构报销要求，以及在使用新的诊断相关群体的医院报销的变化，影响了医疗保险费用的增长。

DESCRIPTION (provided by applicant): Essential to a complete understanding of the comparative effectiveness of new medical technologies in improving population health care outcomes is a complete elucidation of how new technologies increase national health care costs. New technology is widely considered by health economists to be the leading driver of rising U.S. health care costs, yet the precise mechanisms by which new technologies produce cost growth are uncertain. It is likewise uncertain how local-area health care market factors have affected cost increases due to new technology. Finally, it is not well understood how national policy initiatives such as Medicare's Coverage with Evidence Development program, changes in diagnosis-related group (DRG) assignment, and modifications in DRG reimbursement rates have affected the rate of growth in Medicare costs. Implantable cardiovascular devices are among the most costly therapies covered by the Medicare program, and recent Centers for Medicare and Medicaid Services coverage decisions for drug-eluting coronary stents (2003) and carotid arterial stents (2004), as well as expansions of coverage indications for implantable cardioverter defibrillators (2003 and 2005), potentially have entailed billions of dollars in additional annual expenditures for the Medicare program. As such, a clearer understanding of how the introduction of these devices into clinical practice affected Medicare cost growth can critically inform the forecasting of future Medicare expenditures, and thus inform decisions regarding the comparative effectiveness of these new technologies (and similar, future innovations) relative to costs. In this project, we will analyze national Medicare claims data from 2001- 2008 in pursuit of the following goals: (1) to measure the degree to which these 3 new cardiovascular technologies have increased Medicare expenditures, and to assess the proportion of the cost growth that can be attributed to the increases in the direct cost of the technology, expansion in the volume of care, changes in the characteristics of patients undergoing treatment, increases in complementary health care expenditures, and changes in downstream costs; (2) to determine how cost growth due to these 3 new cardiovascular technologies has varied across small geographic areas, and to assess the proportion of technology-related cost growth that is attributable to market-level factors such as the intensity of hospital competition, the presence of cardiac specialty hospitals within a health care market, or the presence of hospitals there were involved in clinical trials of the devices; and (3) to explore how differences in Medicare's coverage decisions and policies regarding these three technologies, including differing institutional requirements for reimbursement as well as variation in the use of new diagnosis-related groups for hospital reimbursement, affected growth in Medicare costs.