In 2006, leaders in the state of Washington created the Health Technology Assessment (HTA) program to evaluate the cost-effectiveness of various medical therapies. With our country facing a huge budget deficit, what could be better than determining which treatments are worth paying for?
The Wall Street Journal published an editorial today that should send shivers up the spine of every American. Entitled The Pro-Diabetes Board, the piece highlights the potential disaster of the "subsidize, mandate, overregulate" insurance model.
The HTA panel is hearing arguments for and against glucose monitoring for children with diabetes, the established standard of diabetes care for over 30 years!
After criticizing past randomized controlled trials of glucose monitoring, the HTA panel is demanding new trials to prove efficacy before the government will continue to pay for this intervention.
Clinicians are in shock. A high-quality trial in 1993 led to an"irrefutable" conclusion: Tight control of blood sugar -- a condition that requires frequent self-monitoring of blood sugar levels -- leads to dramatically improved patient outcomes.
The new trial requested by the HTA program would be unethical. Asking a group of children to not monitor their blood glucose would knowingly put them at increased risk of medical complications.
Here are two powerful arguments against comparative effectiveness research:
- Randomized trials look at average results for large groups of people. But doctors treat individual patients, and what works for the "typical" patient may not work for the patient in question
- Comparative effectiveness is not about informing choices; it's about limiting options.