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Implications of learning effects for hospital costs of new health technologies: the case of intensity modulated radiation therapy.

Bonastre J, Noël E, Chevalier J, Gerard JP, Lefkopoulos D, Bourhis J, Bensadoun RJ, de Pouvourville G,

Gustave Roussy Institute, Villejuif, France. bonastre@igr.fr

OBJECTIVES: The impact of learning effects on the variability of costs of new health technologies in a prospective payment system (PPS) through the case of intensity modulated radiation therapy (IMRT) was studied. METHODS: A series of consecutive patients treated in nine medical centers was enrolled in a prospective study. Direct costs were assessed from the perspective of the healthcare providers. We used a two-level model to explain the variability of costs: patients nested within centers. Learning effects at the center level were considered through a fixed effect (the learning curve slope) and a random effect (the initial cost level). Covariates were introduced to explain the patterns of variation in terms of patient characteristics. RESULTS: The mean direct cost of IMRT was 5,962 euro (range, 2,414 euro-24,733 euro). Manpower accounted for 53 percent of this cost. Learning effects explained 42 percent of the variance between centers (which was 88 percent of the total variance) and were associated with a substantial decrease in treatment costs. The mean initial treatment direct cost was 6,332 euro in centers with a previous experience of IMRT, whereas it was 14,192 euro in centers implementing IMRT for the first time. Including logistics costs and overhead, the full cost of IMRT was 10,916 euro. Average reimbursement was 6,987 euro. CONCLUSIONS: Learning effects are a strong confounding factor in the analysis of costs of innovative health technologies involving learning effects. In a PPS, innovative health technology involving learning effects necessitates specific reimbursement mechanisms.

Published 11 May 2007 in Int J Technol Assess Health Care, 23(2): 248-54.
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