Institute aims to apply evidence in practice
Daniel A. Ollendorf, MPH, of the Institute for Clinical and Economic Review (ICER) in Boston, and colleagues noted that publication of systematic reviews and analysis of preferred approaches in imaging grew by more than 60 percent between 2005 and 2009, but recent trends have seen an increase in the use of diagnostic imaging, driven by factors unrelated to evidence-based practice.
“Indeed, the submission of and payment for imaging claims appear to be largely independent of any concept of suitability for patients, despite the presence of well-accepted guidelines on appropriate imaging practice,” wrote the authors.
Speculating the reasons for this phenomenon, Ollendorf and colleagues suggested there may be too much variability in the quality of evidence. At the same time, there might be too little focus on research that addresses when imaging should be performed at all, with most studies focused on choices between diagnostic modalities.
In an effort to help promote true evidence-based practice, ICER was founded in 2006 to synthesize available evidence and improve decision making in practice.
An example of the ICER approach presented by the authors was an ICER appraisal which compared CT colonography (CTC) with optical colonoscopy for detection of polyps greater than 5 mm in size. The main objective was to compare diagnostic accuracy, relative safety and cost between the strategies, but because no studies directly compared outcomes between the approaches, pooled estimates and modeling were used. The authors wrote that the results showed comparable accuracy and safety between CTC and optical colonoscopy, though the type of safety risks differed between modalities.
On the basis of these findings, the State of Washington’s Health Care Authority issued a noncoverage decision for CTC because CTC claims were being reimbursed at a rate approximately 25 percent higher than that of optical colonoscopy, according to Ollendorf and colleagues.
The authors said that ICER has demonstrated its process can facilitate clinical decision making, particularly for technologies currently in widespread use. “The utility of this approach for truly emerging technologies such as dementia diagnostics is not yet known but appears to have promise as a method for identifying the type of evidence that will reduce uncertainty and enable decision making in the future.”