An Evaluation of the Development and Effectiveness of a Hospital-Based Health Technology Assessment (HB-HTA) Program at the University of Washington Medical Center

Abstract

One of the primary cost drivers for the increase in healthcare costs is new technology, and thirty percent of the overall healthcare spend is from hospitals in the United States. Health technology assessment (HTA) improves new technology adoption decisions by providing a framework within which only those technologies supported by strong evidence are adopted. This dissertation studied the development, implementation and experience of a new hospital-based health technology assessment (HB-HTA) program called Smart Innovation at UW Medicine. Smart Innovation established a formal decision framework including clinicians and executives as well as representatives from supply chain and finance. We describe the methods developed to evaluate new medical technologies, provide the HTA decisions that were made, and report the results of the initiative. In the first two years of the program, we reviewed eleven new technologies and achieved an estimated $ 5.8 million dollars in potential cost savings/avoidance. As part of our analysis, we conducted a case study of one HB-HTA, a new molecular test for bladder cancer (Cxbladder) that underwent review by Smart Innovation. The new and less invasive test appeared to be promising, however, there were concerns about its high cost and low specificity. By not covering Cxbladder at UW Medicine, we estimated annual cost savings and avoidance of $1.5 million dollars. The new test was not adopted system-wide; however, a pilot study was conducted to test the diagnostic yield in a narrow patient context. The pilot was a case series that compared two similar groups that were being monitored for recurrent bladder cancer, one that received the new test (Cxbladder) and one that did not. The pilot study evaluated whether the new test changed patient management, and also if the test in question reduced the number of other diagnostic tests ordered. We also studied the impact of Smart Innovation by comparing technology use at the University of Washington Medical Center (UWMC) to technology use at seventeen similar academic medical centers. The analysis included two technologies, one that underwent Smart Innovation review and one that did not. Specifically, the study compared differences in the number of quarterly surgical procedures and the overall costs between UWMC and control hospitals. Our findings indicated that when UWMC adopted new technologies without HB-HTA review there were no observed differences in utilization compared to control institutions, but when UWMC used HB-HTA methods, there was a reduction in observed utilization and overall costs. Smart Innovation was successfully implemented at UW Medicine and promoted efficiency in its constituent hospitals. The program reduced costs and utilization, and it also provided a framework under which new technologies of uncertain benefit could be piloted. The work presented in this dissertation research thus impacted hospital policy and improved UW Medicine’s approach to new technology adoption. Smart Innovation started as a pilot program funded by a grant, but following implementation and promising early results, it was incorporated into UW Medicine’s Supply Chain Management process. The results of the Cxbladder pilot study likewise changed the institution’s clinical practice for ordering the new molecular test for bladder cancer at UW Medicine. Thus, Smart Innovation improved UW Medicine’s overall approach to new medical technology review and adoption, as it provided an objective and efficient decision framework and process for reviewing new medical technologies.