State will review medical technologies for safety and effectiveness

The state of Washington will have experts review three medical technologies for safety and effectiveness to determine if they should be covered under state health care programs. The procedures were singled out due to concerns expressed by state physicians.

The review is part of the state’s new Health Technology Assessment (HTA) program which will review various medical procedures, tests, and devices for safety, effectiveness, and cost-effectiveness. The next step will be for independent medical experts to thoroughly review the three technologies; then make recommendations as to if or when state agencies could cover their use.

Due to the length of the process, only 14 technologies will be reviewed during the first two years. HTA Director Leah Hole-Curry said the medical technologies will be selected for review based on concerns about the safety of a technology, if it works as intended, and if it is cost-effective.

“While the HTA decisions will only affect state government purchasing decisions, we hope this will eventually be a tool for all health care consumers,” said Hole-Curry. “The HTA serves as an independent reviewer, like Consumer Reports, rating various procedures, sorting through the hype, and summarizing the scientific evidence about whether these procedures are safe, work as claimed, and worth the cost.”

“When we look at cost” Hole-Curry said, “our mission is not to find the cheapest alternative. We will be looking for emerging or fast-growing technologies that could have the biggest impact on the state’s budget.”

A ruling by the independent health care provider committee could either require or prohibit state programs from paying for a certain technology. These state programs provide or pay for health care to approximately one million Washington residents including Medicaid, the Uniform Medical Plan, and Labor and Industries.

The procedures to be reviewed first will be:

• Lumbar Fusion and discography. These procedures would be reviewed when used to treat chronic back pain. Their use for treatment of other conditions, such as a traumatic spinal injury, is a long- accepted practice that is not under review. However, when used for back pain, the procedure is invasive and carries significant additional risk compared with non-surgical treatment. Multiple recent studies have been conducted on whether surgery is effective at curing back pain.

• Pediatric Bariatric Surgery. This surgery to physically limit calorie intake and to induce weight loss for obese individuals has been used successfully for a number of years. However, its use for children under the age of 18 has been questioned by many health experts. About 15 percent of children are believed to be clinically obese. The health risks of the condition are high, but there is concern as to the surgery’s safety for adolescents, as well as its effectiveness in maintaining weight loss.

• Upright/positional MRI. This is an emerging diagnostic-imaging technology that permits multiple positions and weight-bearing images. There is high concern over diagnostic accuracy leading to poor or worse diagnosis and inappropriate care, especially compared with traditional MRI technology. Imaging technology utilization is standard for multiple, common conditions including shoulder, knee, and spinal injuries and pain.

The review process for these technologies will take up to six months to complete. The process includes gathering public input at the beginning of the review from the program’s Web site at http://www.hca.wa.gov/hta until February 5. Following the review, the Health Technology Clinical Committee made up of 11 independent, practicing health care professionals will review the evidence at a public meeting where additional public input is also collected. They will determine:

• The safety and effectiveness of each technology.

• If Washington state agencies will pay for the technology.

• The circumstances under which a technology would be covered.