Contents

• THE NATIONAL ACADEMIES
• THE COMMITTEE ON MEDICAL INNOVATION IN THE CHANGING HEALTHCARE MARKETPLACE
• THE BOARD ON SCIENCE, TECHNOLOGY, AND ECONOMIC POLICY
• THE BOARD ON HEALTH CARE SERVICES
• Preface
• Executive Summary
• 1. Introduction
  • THE CONFERENCE AGENDA
• 2. The Characteristics of Medical Innovation
  • MEDICAL INNOVATION SHOULD NOT BE TOO NARROWLY DEFINED
  • DEVICES AND DRUGS ARE DIFFERENT IN THEIR COST-EFFECTIVENESS OVER TIME
  • REFERENCES
• 3. The Costs and Benefits of Medical Innovation
  • ACCORDING TO CMS RESEARCHERS, TECHNOLOGY IS PRIMARY DRIVER OF HEALTH CARE COSTS
  • INCREASED USE OF EXISTING DRUGS IS MOST IMPORTANT DRIVER OF AGGREGATE DRUG COSTS
  • THE VALUE OF INCREASED LIFE EXPECTANCY OVER 1970–1990 IS ENORMOUS
  • MAJOR RETURNS ON INVESTMENT IN MEDICAL TECHNOLOGY FOR CARDIOVASCULAR DISEASE
  • SIGNIFICANT POTENTIAL BENEFITS FROM MELANOMA PREVENTION PROGRAMS
  • LOOKING TO THE FUTURE: COSTS OF TREATING CARDIOVASCULAR DISEASE LIKELY TO RISE
  • NEW THERAPIES FOR METASTATIC MELANOMA ARE EXPENSIVE
  • SOME RECENT DEVELOPMENTS IN IMMUNOTHERAPY FOR TREATING METASTATIC MELANOMA
  • REFERENCES
• 4. Cost-Effectiveness Studies: A Key to Innovation Development
  • TISSUE PLASMINOGEN ACTIVATOR (t-PA) CASE HISTORY
  • IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICDs) CASE HISTORY
  • INTRAVASCULAR ULTRASOUND (IVUS) CASE HISTORY
  • MEDICAL USAGE OFTEN PRECEDES EFFICACY ASSESSMENT
  • EVALUATION CHALLENGES FACING METASTATIC MELANOMA AND OTHER CANCERS
  • CONSUMER GROUPS CAN HELP FOSTER INNOVATION
  • ROUTES FOR NEW TECHNOLOGY INTO THE MEDICARE PROGRAM
  • DEVELOPING A MORE SEAMLESS APPROVAL AND COVERAGE PROCESS
  • REFERENCES
• 5. Barriers to Medical Innovation
  • TECHNICAL-LEVEL BARRIERS
  • PUBLIC POLICY BARRIERS
  • HIGH-LEVEL POLITICAL/ECONOMIC BARRIERS
  • REFERENCES
• Appendixes
  • A Conference Agenda
  • B Conference Participant List
  • C Keynote Speech: Encouraging High-Value Medical Innovation
  • D Keynote Speech: Bridging the Quality Chasm

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report was supported by funding from the Department of Veterans Affairs, the Alfred P. Sloan Foundation, Philips Medical Systems, (formerly part of Agilent Technologies' Healthcare Solutions Group, and before that, part of Hewlett-Packard), KeraVision, Inc., and Pfizer, Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.