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The Artificial Heart: Costs, Risks, and Benefits—An Update

Published online by Cambridge University Press:  10 March 2009

Deborah P. Lubeck
Affiliation:
SysteMetrics, Inc., Santa Barbara, California

Extract

For several decades, major advances in medicine have increased dramatically our ability to prevent, diagnose, and manage a wide variety of chronic and acute health problems. However, medical innovations also pose significant economic, social, and ethical questions. How do we best utilize scarce medical resources? How do we balance anticipated benefits against the dollar cost or associated risk? What is the impact on total health care spending now and in future years? As concern over these issues grows concomitant with increased health care spending, technology assessment is often promoted as a method for determining whether a biomedical innovation should be encouraged to disseminate rapidly in order to maximize its benefits to individual patients, or constrained to develop slowly in order to minimize collective costs or risks. But, the art and practice of evaluating medical technologies, especially innovations still in the research and development phase, are not well developed (6;8;11;14;16;34;35).

Type
Special Section: Transplantation and Artificial Organs
Copyright
Copyright © Cambridge University Press 1986

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References

REFERENCES

1.Aaron, H. J. & Schwartz, W. B.The painful prescription: rationing hospital care. Washington, DC: The Brookings Institution, 1984.Google Scholar
2.Altman, S. H. & Blendon, R. J.Medical technology: The culprit behind health care costs? DHEW Publication (PHS). Washington, DC: Government Printing Office, 1979.Google Scholar
3.American Hospital Association. Hospital statistics: 1983 edition. Chicago: American Hospital Association, 1983.Google Scholar
4.American Medical Association. Physician characteristics and distribution in the U.S.: 1982. Chicago: American Medical Association, 1983.Google Scholar
5.Artificial Heart Working Group. Report of the Artificial Heart Working Group. Artificial Organs, 1982, 6, 335–40.Google Scholar
6.Banta, H. D. (ed.). Resources for health: Technology assessment for policy making. New York: Praeger, 1982.Google Scholar
7.Banta, H. D. & Behney, C. J.Policy formulation and technology assessment. Milbank Memorial Fund Quarterly, 1981, 59, 445–79.CrossRefGoogle ScholarPubMed
8.Banta, H. D., Behney, C. J., & Williams, J. S.Toward rational technology in medicine. New York: Springer Publishing Co., 1981.Google ScholarPubMed
9.Bunker, J. P., Fowles, J., & Schaffarzick, R.Evaluation of medical technology strategies: I. Defects of coverage and reimbursement. New England Journal of Medicine, 1982, 306, 620–24.CrossRefGoogle Scholar
10.Chiang, B. M.Introduction to stochastic processes in biostatistics. New York: Wiley and Sons, 1968.Google Scholar
11.Committee on Technology and Health Care. Medical technology and the health care system. Washington, DC: National Academy of Sciences, 1979.Google Scholar
12.DeVries, W. C., Anderson, J. L., Joyce, W., et al. Clinical use of the total artificial heart. New England Journal of Medicine, 1984, 310, 273–78.CrossRefGoogle ScholarPubMed
13.DeVries, W. C. & Joyce, L. D.The artificial heart. Clinical Symposia, 1983, 35, 432.Google ScholarPubMed
14.Egdahl, R. H. & Gertman, P. M. (eds.). Technology and the quality of health care. Germantown, MD: Aspen Systems, 1978.Google Scholar
15.Evans, R. W., Manninen, E. L., Garrison, L. P., et al. The quality of life of patients with end-stage renal disease. New England Journal of Medicine, 1985, 312, 553–59.CrossRefGoogle ScholarPubMed
16.Fineberg, H. V. & Hiatt, H. H.Evaluation of medical practices: The case of technology assessment. New England Journal of Medicine, 1979, 301, 1086–91.CrossRefGoogle ScholarPubMed
17.Garrison, L. P. The medical costs of heart transplantation. In Evans, R. W., Manninen, O. L., Overcast, T. D., et al. The National Heart Transplantation Study: Final Report. Seattle, WA: Battelle Human Affairs Research Center, 1984.Google Scholar
18.DrJarvik, Robert. Personal communication. April, 1985.Google Scholar
19.Jarvik, R. K.The total artificial heart. Scientific American, 1981, 244, 7480.CrossRefGoogle ScholarPubMed
20.Levy, N. B. (ed.). Living or dying. Springfield, IL: Charles C Thomas, 1979.Google ScholarPubMed
21.Lubeck, D. P. & Bunker, J. P.The artificial heart: Costs, risks, and benefits. Case Study No. 9. U.S. Congress, Office of Technology Assessment. Washington, DC: Government Printing Office, 1982.Google Scholar
22. Medical miracles: But how to pay the bill? Time (December) 1984, 7085.Google Scholar
23. Medical News: Artificial heart still holds promise. Journal of the American Medical Association, 1985, 253, 2805–19.CrossRefGoogle Scholar
24. Medical News: Another artificial heart receives FDA approval for clinical trials. Journal of the American Medical Association, 1985, 253, 2617–21.CrossRefGoogle Scholar
25.Moloney, T. W. & Rogers, D. E.Medical technology: A different view of the contentious debate over costs. New England Journal of Medicine 1979, 301, 1413–19.CrossRefGoogle ScholarPubMed
26.Preston, T. Appendix D in D. P. Lubeck & J. P. Bunker. The artificial heart: Costs, risks, and benefits. Case Study No.9. U.S. Congress, Office of Technology Assessment. Washington D.C.: Government Printing Office, 1982.Google Scholar
27.Preston, T.Coronary artery surgery. New York: Raven Press, 1979.Google Scholar
28.Reiss, J. B., Hellinger, E., & Burckhardt, J. Issues in the cost and regulation of new medical technologies and procedures: Heart transplants as a case study. In McNeil, B. J. & Cravalho, E. G. (eds.), Critical Issues in Medical Technology. Boston, MA: Auburn House, 1982.Google Scholar
29.Rettig, R. A. & Webster, T. C. Implementation of the end-stage renal disease program: A mixed pattern of subsidizing and regulating the delivery of medical services. In Friedman, K. & Radkoff, S. (eds.), Toward a national health policy. Lexington, MA: Lexington Books, 1977.Google Scholar
30.Rosenberg, G., Snyder, A., Pierce, W. S., et al. Engineering development of the mechanical heart. In McNeil, B. J. & Cravalho, E. G. (eds.), Critical issues in medical technology. Boston, MA: Auburn House, 1982.Google Scholar
31.Scitovsky, A. A. & McCall, N.Changes in the costs of treatment of selected illness, 1951–1964–1971. DHEW Publication (HRA); 77–3161. Washington, DC: Government Printing Office, 1981.Google Scholar
32.Schaeffer, L. K. Role of HCFA in the regulation of new medical technologies In McNeil, B. J. & Cravalho, E. G. (eds.), Critical issues in medical technology. Boston, MA: Auburn House, 1982.Google Scholar
33.Shepard, D. S. & Zeckhauser, R. J.Long-term efffects of interventions to improve survival in mixed populations. Journal of Chronic Diseases, 1980, 33, 413–33.CrossRefGoogle Scholar
34.U.S. Congress, Office of Technology Assessment. Cost-effectiveness analysis of medical technology. Background paper No. 1. Washington, DC: Government Printing Office, 1980.Google Scholar
35.Warner, K. D. & Luce, B. R.Cost-benefit and cost-effectiveness analyses in health care. Ann Arbor, MI: Health Administration Press, 1982.Google Scholar
36.Woolley, F. R.Ethical issues in the implantation of the artificial heart. New England Journal of Medicine, 1984, 310, 292–96.CrossRefGoogle ScholarPubMed