Date and Time
April 18, 2007
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Peter Groeneveld - University of Pennsylvania

Recent Food and Drug Administration approvals of drug-eluting coronary stents (2003) and carotid arterial stents with cerebral protection (2004), as well as the expansion of Medicare coverage for implantable cardioverter-defibrillators for primary prevention of sudden cardiac death (2003 and 2005) by the Centers for Medicare and Medicaid Services (CMS), have made hundreds of thousands of elderly Medicare beneficiaries newly eligible recipients of expensive medical technologies.

These coverage decisions also entail substantial new expenditures on cardiovascular health care. Given current reimbursement incentives, it is likely that hospitals and health care systems may overuse or misuse new technologies (e.g., implantation of devices in clinically inappropriate recipients, or excessive complication rates) that will yield unfavorable cost- to-benefit ratios. In preparation for this, payers like CMS have recently instituted new policies such as coverage with evidence determination, the goal of which is to ensure that new technologies are used both effectively and efficiently in non-experimental clinical settings.

Unfortunately, it is increasingly apparent that both the introduction of new technologies and the regulations designed to improve the efficiency of technology adoption have the potential to widen racial and socioeconomic disparities in health care. To illustrate these effects, I will review theoretical and empirical work in this area, including our own initiatives to examine technology diffusion and disparities in the use of therapeutic cardiovascular devices such as implantable cardioverter-defibrillators, drug-eluting coronary stents, and carotid arterial stents with embolic protection.