Rofo 2019; 191(07): 635-642
DOI: 10.1055/a-0838-6253
Review
© Georg Thieme Verlag KG Stuttgart · New York

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Article in several languages: English | deutsch
Carolin Winkelmann
1   Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany
5   Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
,
Thomas Neumann
1   Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany
5   Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
,
Jan Zeidler
2   Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Anne Prenzler
2   Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Bodo Vogt
1   Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany
4   Chair in Health Economics, Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Germany
5   Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
,
Frank K. Wacker
3   Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
5   Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
› Author Affiliations
Further Information

Publication History

27 August 2018

20 December 2018

Publication Date:
14 February 2019 (online)

Abstract

Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects.

Method This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation” for inpatients and “authorization right” for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies.

Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector.

Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures.

Key Points:

  • HTAs should be a basic component of evidence-based radiology.

  • G-BA’s authority implicitly creates a paradox in terms of inventives to implement and finance HTAs.

  • University hospitals and public funding institutions need to support studies that assess the benefit of radiological procedures.

Citation Format

  • Winkelmann C, Neumann T, Zeidler J et al. Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply. Fortschr Röntgenstr 2019; 191: 635 – 642

 
  • Literatur

  • 1 Prenzler A, von der Schulenburg JMG. Institutionen der Vierten Hürde. In: Schoffski O, von der Schulenburg JMG. (eds) Gesundheitsökonomische Evaluationen. 4th. ed Berlin, Heidelberg: Springer-Verlag; 2012: 437-456
  • 2 Statistisches Bundesamt. Anzahl der medizinisch-technischen Großgeräte in deutschen Krankenhäusern nach Gerätetyp in den Jahren von 2012 bis 2016. Statista – Das Statistik-Portal, n.d. https://de.statista.com/statistik/daten/studie/166519/umfrage/medizinisch-technische-grossgeraete-in-krankenhaeusern
  • 3 Statistisches Bundesamt. Anzahl der Krankenhäuser in Deutschland in den Jahren 2000 bis 2016. Statista – Das Statistik-Portal, n.d. https://de.statista.com/statistik/daten/studie/2617/umfrage/anzahl-der-krankenhaeuser-in-deutschland-seit-2000
  • 4 Grobe TG, Dörning H, Schwartz FW. BARMER GEK Arztreport 2011: Schwerpunkt: Bildgebende Diagnostik – Computer- und Magnetresonanztomografie. St. Augustin: Asgard-Verlag; 2011
  • 5 Greiner W. Health Technology Assessment (HTA). In: Schoffski O, von der Schulenburg JMG. (eds) Gesundheitsökonomische Evaluationen. 4th. ed Berlin, Heidelberg: Springer-Verlag; 2012: 457-479
  • 6 Scottish Intercollegiate Guidelines Network (SIGN). SIGN 50: a guideline developer’s handbook. Edinburgh: 2015
  • 7 Kunz R, Ollenschläger G, Raspe H. et al. Lehrbuch evidenzbasierte Medizin in Klinik und Praxis. 2nd. ed Köln: Dt. Ärzte-Verl; 2007
  • 8 The Evidence-Based Radiology Working Group. Evidence-based radiology: A new approach to the practice of radiology. Radiology 2001; 220: 566-575
  • 9 Mehanna H, Wong WL, McConkey CC. et al. PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer. The New England Journal of Medicine 2016; 374: 1444-1454
  • 10 Mehanna H, McConkey CC, Rahman JK. et al. PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography-computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2 / N3) nodal metastases in patients with squamous cell head and neck cancer. Health Technology Assessment 2017; 21: 1-122
  • 11 Drummond MF, Sculpher MJ, Claxton K. et al. Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press; 2015
  • 12 Mant D, Gray A, Pugh S. et al. A randomised controlled trial to assess the cost-effectiveness of intensive versus no scheduled follow-up in patients who have undergone resection for colorectal cancer with curative intent. Health Technology Assessment 2017; 21: 1-86
  • 13 Hollingworth W, Jarvik JG. Technology assessment in radiology: Putting the evidence in evidence-based radiology. Radiology 2007; 244: 31-38
  • 14 Hinrichs JB, Hasdemir DB, Nordlohne M. et al. Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization. CardioVascular and Interventional Radiology 2017; 40: 1559-1566
  • 15 Bernstein OA, Campbell J, Rajan DK. et al. Randomized Trial Comparing Radiologic Pigtail Gastrostomy and Peroral Image-Guided Gastrostomy: Intra- and Postprocedural Pain, Radiation Exposure, Complications, and Quality of Life. Journal of Vascular and Interventional Radiology 2015; 26: 1680-1686
  • 16 Marker DR, Perosi N, Ul Haq F. et al. Percutaneous Cecostomy in Adult Patients: Safety and Quality-of-Life Results. Journal of Vascular and Interventional Radiology 2015; 26: 1526-1532.e1
  • 17 Swan JS, Pandharipande PV, Salazar GM. Developing a Patient-Centered Radiology Process Model. Journal of the American College of Radiology 2016; 13: 510-516
  • 18 Siebert U, Jahn B, Mühlberger N. et al. Entscheidungsanalyse und Modellierungen. In: Schoffski O, von der Schulenburg JMG. (eds) Gesundheitsökonomische Evaluationen. 4th. ed Berlin, Heidelberg: Springer-Verlag; 2012: 275-324
  • 19 Bundesministerium der Finanzen. AfA-Tabelle für den Wirtschaftszweig „Gesundheitswesen“ (Aktenzeichen: IV A 8-S 1551-7/95). 1995 http://www.bundesfinanzministerium.de/Content/DE/Standardartikel/Themen/Steuern/Weitere_Steuerthemen/Betriebspruefung/AfA-Tabellen/1995-01-13-afa-23.pdf?__blob=publicationFile&v=3
  • 20 Lagier H. Stellungnahme zur Geräteausstattung in Radiologischen/Neuroradiologischen Universitätskliniken. 2012 http://www.dfg.de/download/pdf/foerderung/programme/wgi/stellungnahme_radiologie.pdf
  • 21 Hess R. Die ordnungspolitische Funktion einer einheitlichen Leistungsgestaltung – der Gemeinsame Bundesausschuss und das Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen. In: Rebscher H. (ed) Gesundheitsökonomie und Gesundheitspolitik im Spannungsfeld zwischen Wissenschaft und Politikberatung. Heidelberg: Economica Verlag; 2006: 441-458
  • 22 Felder-Puig R, Mad P, Gartlehner G. Diagnostische Studien. Wiener Medizinische Wochenschrift 2009; 159: 359-366
  • 23 Gizewski ER, Forsting M, Krombach GA. et al. Health Technology Assessment (HTA): Entwicklung im Gesundheitswesen und Potenzial in der Radiologie. Der Radiologe 2014; 54: 589-598
  • 24 Teljeur C, Moran P, Harrington P. et al. The HIQA’s Health Technology Assessment of Breast Screening: Highlighting Some of the Challenges Posed by Evaluations of Screening Programs. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research 2017; 20: 1000-1002
  • 25 Field JK, Duffy SW, Baldwin DR. et al. The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer. Health technology assessment (Winchester, England) 2016; 20: 1-146
  • 26 Qureshi NR, Rintoul RC, Miles KA. et al. Accuracy and cost-effectiveness of dynamic contrast-enhanced CT in the characterisation of solitary pulmonary nodules-the SPUtNIk study. BMJ open respiratory research 2016; 3: e000156
  • 27 Universitätsklinik für Radiologie und Nuklearmedizin Magdeburg. RAD294-COMPARE Onko PET: Vergleich der diagnostischen Genauigkeit zwischen PET/CT und PET/MR bei onkologischen Fragestellungen. 2016 https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009720
  • 28 Ruile G, Djanatliev A, Kriza C. et al. Screening for breast cancer with Breast-CT in a ProHTA simulation. Journal of comparative effectiveness research 2015; 4: 553-567
  • 29 Halligan S, Dadswell E, Wooldrage K. et al. Computed tomographic colonography compared with colonoscopy or barium enema for diagnosis of colorectal cancer in older symptomatic patients: two multicentre randomised trials with economic evaluation (the SIGGAR trials). Health technology assessment (Winchester, England) 2015; 19: 1-134
  • 30 Wardlaw J, Brazzelli M, Miranda H. et al. An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation. Health Technology Assessment 2014; 18: 1-368, v-vi
  • 31 Kisser A, Mayer J, Wild C. Opportunities and strategies to drive appropriate use of MRI in Austria: LBI-HTA Projektbericht Nr.: 80. Wien: Ludwig Boltzmann Institut für Health Technology Assessment; 2014
  • 32 Steadman R, Myers RP, Leggett L. et al. A Health Technology Assessment of Transient Elastography in Adult Liver Disease. Canadian Journal of Gastroenterology 2013; 27: 149-158
  • 33 Westwood M, Joore M, Grutters J. et al. Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2013; 17: 1-243
  • 34 Gorenoi V, Schönermark MP, Hagen A. CT-Koronarangiografie versus konventionelle invasive Koronarangiografie bei der KHK-Diagnostik: DIMDI. 2012
  • 35 Busse R, Orvain J, Velasco M. et al. Best practice in undertaking and reporting health technology assessment – Working group 4 report. International Journal of Technology Assessment in Health Care 2002; 18: 361-422