Should We Use Outcomes-Based Pricing for Medical Devices?

Health3-0.com – April 6, 2018

If you have predictable patterns of chest pain, you may be diagnosed with stable angina. When deciding on a treatment, your decision may involve people outside your exam room. Treatment options include lifestyle changes, medical therapy (drugs) and a procedure that inserts a catheter into your coronary arteries to place a stent to improve blood flow to the heart. The procedure is called Percutaneous Coronary Intervention (PCI). 

The lifestyle changes and medical therapy options could be selected by you (the patient) and your physician. PCI may require prior authorization by your insurance company that may determine the potential benefit is not worth the cost or that they want you to try lifestyle changes and medical therapy first. While PCI has produced great outcomes for many people with stable angina, a 2007 study found that overall, PCI is no better than optimal medical therapy at alleviating symptoms. Physicians, insurance companies and device makers (stent) may each have different opinions as to whether the costs and risk outweigh your potential benefit from PCI.

See more about the complexity of medical decison making and why health outcomes is often not part of the decision.