Iribarne Alexander, Russo Mark J, Moskowitz Alan J, Ascheim Deborah D, Brown Lawrence D, Gelijns Annetine C
International Center for Health Outcomes and Innovation Research, Department of Health Policy, Mount Sinai School of Medicine, New York, New York 10029, USA.
Semin Thorac Cardiovasc Surg. 2009 Spring;21(1):28-34. doi: 10.1053/j.semtcvs.2009.05.001.
Technological innovation--broadly defined as the development and introduction of new drugs, devices, and procedures--has played a major role in advancing the field of cardiothoracic surgery. It has generated new forms of care for patients and improved treatment options. Innovation, however, comes at a price. Total national health care expenditures now exceed $2 trillion per year in the United States and all current estimates indicate that this number will continue to rise. As we continue to seek the most innovative medical treatments for cardiovascular disease, the spiraling cost of these technologies comes to the forefront. In this article, we address 3 challenges in managing the health and economic impact of new and emerging technologies in cardiothoracic surgery: (1) challenges associated with the dynamics of technological growth itself; (2) challenges associated with methods of analysis; and (3) the ways in which value judgments and political factors shape the translation of evidence into policy. We conclude by discussing changes in the analytical, financial, and institutional realms that can improve evidence-based decision-making in cardiac surgery.
技术创新——广义上定义为新药、设备和手术方法的研发与引入——在推动心胸外科领域发展方面发挥了重要作用。它为患者带来了新的护理形式，改善了治疗选择。然而，创新是有代价的。美国目前全国医疗保健总支出每年超过2万亿美元，而且所有当前估计都表明这个数字将持续上升。在我们继续为心血管疾病寻求最具创新性的医疗治疗方法时，这些技术不断攀升的成本成为了首要问题。在本文中，我们探讨了在管理心胸外科新技术和新兴技术对健康及经济影响方面的三个挑战：（1）与技术增长动态本身相关的挑战；（2）与分析方法相关的挑战；（3）价值判断和政治因素影响证据转化为政策的方式。我们通过讨论分析、财务和机构领域的变化来结束本文，这些变化可以改善心脏外科基于证据的决策制定。
