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PubMed1996

Outcomes measurement: health state preferences and economic evaluation.

A major health care policy issue in this era of accountability is controlling the introduction and utilization of increasingly sophisticated and expensive health care technologies. Data are needed about both the effectiveness and the costs of assistive technologies before making decisions without relying on "that's what we did last time," "gut feelings," or even "educated guesses." Services, such as assistive technology, fall in the category where rigorous scientific evidence about cost-effectiveness is virtually nonexistent. The field of medical technology assessment has been studying cost-effectiveness for decades and offers many methodological ideas to related fields such as assistive technology. Based on the experiences of medical technology assessment, the measurement of health state preferences and its use to estimate quality-adjusted life years is discussed in this paper. Economic evaluation can be defined as the comparative analysis of alternative courses of action in terms of both costs and consequences. Information from economic evaluation studies, including the use of quality-adjusted life years as an outcome measure, helps us to determine which health care services we can afford to incorporate into routine clinical practice. The major forms of economic evaluation for health care described in this paper are cost-benefit, cost-effectiveness, and a special form of cost-effectiveness, cost-utility. Important national and state health care policies are being considered and implemented on the basis of economic evaluation data and these are bound to have major implications for assistive technology. The assistive technology field needs to be aware of these methods both to understand how large scale health-related policy decisions are impacted by economic evaluations and to become participants in and contributors to this process.

Cost-Benefit Analysis↗
PubMed2002

Future AAC technology needs: consumer perspectives.

This article suggests the need for rethinking the role that consumer perspectives will play (and ought to play) in the design and development of future augmentative and alternative communication (AAC) technologies. After carefully defining what they mean by "AAC consumers," "consumer perspectives," and "AAC technologies," the authors consider the extent to which current research has illuminated our understanding of (1) how consumers view AAC technologies and (2) how consumers themselves would define future technology needs. It's not a pretty picture. While it is clear that there already exist specific constructs and methods that could enable researchers and developers to learn more about consumer perspectives, it is equally clear that few, if any, researchers make much use of these constructs and methods. The authors focus specifically on ways that consumer perspective can helpfully infuse participatory action research, technology transfer processes, and ergonomics. In addition, the authors consider how research that investigates the ways in which assistive technologies impact the daily lives of individuals with severe communication impairment also influences public policy issues, which can in turn affect future definitions of AAC technology needs. Throughout the article, the authors advocate for a paradigm shift in the quantity and quality of the collaborations that occur between AAC consumers and AAC researchers, manufacturers, and developers. Augmented communicators and their families have a major stake in all types of research that can affect the design and development of AAC devices and accessories, and the results of this research, in turn, can affect public policy decisions about AAC technologies. This makes it all the more important that AAC consumers be involved at each step of the research and development process.

Communication Devices for People with Disabilities↗
PubMed2003

Actor-network theory: a tool to support ethical analysis of commercial genetic testing.

Social, ethical and policy analysis of the issues arising from gene patenting and commercial genetic testing is enhanced by the application of science and technology studies, and Actor-Network Theory (ANT) in particular. We suggest the potential for transferring ANT's flexible nature to an applied heuristic methodology for gathering empirical information and for analysing the complex networks involved in the development of genetic technologies. Three concepts are explored in this paper--actor-networks, translation, and drift--and applied to the case of Myriad Genetics and their commercial BRACAnalysis genetic susceptibility test for hereditary breast cancer. Treating this test as an active participant in socio-technical networks clarifies the extent to which it interacts with, shapes and is shaped by people, other technologies, and institutions. Such an understanding enables more sophisticated and nuanced technology assessment, academic analysis, as well as public debate about the social, ethical and policy implications of the commercialization of new genetic technologies.

Breast Neoplasms↗
PubMed1991

Clinical and economic evaluation of health care technologies: a joint and sequential approach.

Promising new technologies have to be carefully analyzed before their integration into clinical practice. Moreover, the existing technologies need to be confronted with the new ones in terms of effectiveness and efficiency. Logical guidelines for both clinical and economic evaluation are described in the present review paper which mainly deals with diagnostic technology. All the proposed steps are not instrumental for each technology assessment but they provide a more rational approach to the acceptance and diffusion of technology.

Cost-Benefit Analysis↗
PubMed2006

Label-free cell-based assays with optical biosensors in drug discovery.

Once viewed solely as a tool for low throughput and kinetic analysis of biomolecular interactions, optical biosensors are gaining widespread uses in drug discovery because of recent advances in instrumentation and experimental design. These advances have expanded the capabilities of optical biosensors to meet the needs at many points in the drug discovery process. Concurrent shifts in drug discovery paradigms have seen the growing use of whole cell systems for drug screens, thus creating both a need in drug discovery and a solution in optical biosensors. This article reviews important advances in optical biosensor instrumentation, and highlights the potential of optical biosensors for drug discovery with an emphasis on whole cell sensing in both high throughput and high content fashions.

Biological Assay↗
PubMed2006

Dynamic and label-free cell-based assays using the real-time cell electronic sensing system.

Cell-based assays have become an integral part of the preclinical drug development process. Recently, noninvasive label-free cell-based assay technologies have taken center stage, offering important and distinct advantages over and in addition to traditional label-based endpoint assays. Dynamic monitoring of live cells, the preclusion of label, and kinetics are some of the fundamental features of cell-based label-free technologies. In this article we will discuss the real-time cell electronic sensing (RT-CES, ACEA Biosciences Inc., San Diego, CA) system and some of its key applications for cell-based assays such as cell proliferation and cytotoxicity, functional assays for receptor-ligand analysis, cell adhesion and spreading assays, dynamic monitoring of endothelial barrier function, and dynamic monitoring of cell migration and invasion. Also, where appropriate we will briefly discuss other label-free technologies in an application-specific manner.

Biological Assay↗
PubMed2006

Cellular dielectric spectroscopy: a label-free comprehensive platform for functional evaluation of endogenous receptors.

The CellKey (MDS Sciex, South San Francisco, CA) system enables comprehensive pharmacological evaluation of cell surface receptors, including G-protein coupled receptors (GPCRs) and tyrosine kinase receptors, using adherent and suspension cell lines and primary cells. A unique application enabled by the ability of the CellKey system to reliably quantify activation of endogenous receptors is receptor panning. This application allows investigators to easily screen disease-relevant cell types for functionally active target receptors by treating cells with a panel of receptor-specific ligands. Receptor panning of multiple cell types including Chinese hamster ovary, human embryonic kidney 293, HeLa, U-937, U-2 OS, and TE671 cells resulted in the identification of many functionally active, differently coupled endogenous GPCRs, some of which have not been previously documented in the literature. Upon detecting GPCR activation in live cells, unique cellular dielectric spectroscopy (CDS) response profiles are generated within minutes that reflect the signaling pathways utilized and have been shown to be characteristic of Gs, Gq, and Gi GPCRs. The fact that the CDS response profiles are predictive of the G-protein coupling mechanism of the receptor was demonstrated by using examples of subtype-selective agonists/antagonists to identify the subtypes of the endogenous histamine and beta-adrenergic receptors expressed in U-2 OS cells. A direct correlation is shown between receptor subtype G-protein coupling and CDS response profile. In addition, complex pharmacology, including detection of partial agonism and Schild analysis for endogenous receptors, is presented. The CellKey system allows investigators to conduct studies using endogenously expressed receptors to generate data that are physiologically relevant and in disease context.

Biological Assay↗
PubMed1993

Principles of cost effectiveness analysis for the assessment of current and new therapies.

Economic issues have a prominent place in the debate about reforming the U.S. health care system. If more rational allocations of health care resources are to occur, the principles of decision analysis and clinical economics will need to be understood and used to assess current and new technologies. This requires an explicit assessment of the costs and benefits of a health care intervention, defining the current standard intervention, and clarifying the perspective of the assessment (societal, patient, payer, or provider). Detailed cost accounting of resources is optimal in contrast to costs or charges. These principles were included in 1992 proposed Canadian guidelines for using economic evaluations for adoption of new technologies. Such guidelines provide further impetus for the economic assessment of phase III clinical trials. When applied to peripheral blood progenitor cells, future studies should assess the incremental benefits of the strategy using the progenitor cells, not just the cost savings compared to traditional autologous bone marrow transplantation.

Canada↗
PubMed1993

Medical technology and inequity in health care: the case of Korea.

There has been a rapid influx of high cost medical technologies into the Korean hospital market. This has raised concerns about the changes it will bring for the Korean health care sector. Some have questioned whether this diffusion will necessarily have positive effects on the health of the overall population. Some perverse effects of uncontrolled diffusion of technologies have been hinted in recent literature. For example, there is a problem of increasing inequity with the adoption of expensive technologies. Utilization of most of the expensive high technology services is not covered by national health insurance schemes; examples of such technologies are Ultra Sonic, CT Scanner, MRI, Radiotherapy, EKG, and Lithotripter. As a result, the rich can afford expensive high technology services while the poor cannot. This produces a gradual evolution of classes in health service utilization. This study examines how health service utilization among different income groups is affected by the import of high technologies. It discusses changes made within the health care system, and explains the circumstances under which the rapid and excessive diffusion of medical technologies occurred in the hospital sector.

Cost-Benefit Analysis↗
PubMed1993

Technology assessment in diagnostic imaging. A proposal for a phased approach to evaluating radiology research.

RATIONALE AND OBJECTIVES: The authors propose an objective basis for critical evaluation of research trends and define and analyze a sample of radiology studies according to research phase. METHODS: A random sample of 146 original diagnostic studies from two radiology journals was categorized according to phase, modality, and design by three physician reviewers, collated with a microcomputer database, and analyzed using an SAS program. RESULTS: Phase 1 studies (technical evaluation) constituted 18.5% of publications: phase 2 (standardization and tissue characterization), 10.3%; phase 3 (spectrum of appearances), 40.4%; phase 4 (diagnostic efficacy), 21.2%; and phase 5 (clinical evaluation), 9.6%. Of 48 diagnostic efficacy studies, 42% were prospective (versus 35% for the total sample), 38% were controlled (median sample size, 53 [versus 30 for the total sample]). Only 27% of the 48 diagnostic efficacy studies were externally funded. Research in magnetic resonance imaging (MRI), which comprised 45% of all publications, was oriented toward phase 1 (32%) rather than phase 5 studies (0%). Phase 5 studies were the focus of 18% and 8% of ultrasound (US) and computed tomography (CT) studies, respectively. There were more prospective, controlled efficacy studies in US than in MRI or CT. CONCLUSIONS: Analyses of research trends will be facilitated by use of a standard taxonomy which adopts a modality-based, phased approach.

Diagnostic Imaging↗
PubMedDate not supplied

The role of technology in rising healthcare costs.

Historically, science and technology have been considered a means to improve the quality of life and to foster economic growth. Technology applied to healthcare has unquestionably improved the quality of life; however, the economic implications of the use of technology in medicine have created considerable controversy. How much technology is responsible for the total cost of healthcare is not clear because its role in rising costs follows the biases of who is doing the analysis. Only addressing the appropriate use of technology in medicine will result in improved health outcomes and long-term healthcare savings.

Economic Competition↗
PubMed1987

The high cost of medical technology. Getting at the heart of the matter.

This article presents a review of the development of coronary care units (CCUs) as a paradigm for the uncritical acceptance of technology in medical services. Studies comparing CCU with other settings for treatment of acute myocardial infarction are described in which intensive care is not shown to offer a consistent benefit over more conservative treatment. The proliferation of CCUs as it relates to corporate involvement in medical research (as argued by Waitzkin) is presented. Finally, methodologies now being applied to improve patient selection for CCU services are summarized.

Coronary Care Units↗