Hospitals that invest in high-cost cancer technologies do not do so lightly. It is, they argue, not only critical to their mission of offering patients the best possible care, but it is also a business imperative.
Andrew Pecora, MD, chairman and executive administrative director of the John Theurer Cancer Center at Hackensack (NJ) University Medical Center, says it should not be taboo to question a treatment that is no better or only marginally better than others but costs much more. The trick, he says, is defining what is marginally better.
Pecora cites four steps to making a decision about investing in new technology. "First and foremost, we have to believe that it's materially better than the existing technologies for the patients," he says. "Then we do a financial analysis to determine whether or not the cost of capital will be offset by an appropriate return on investment, like any other business makes a capital investment business decision." Access is another consideration—are there geographic or regulatory barriers? Finally, the technology should be one that the clinicians who would use it want and are excited about, he says.
Any organization with the money and resources to do so can buy cancer diagnosis and treatment technologies, says Anurag Agarwal, MD, chief of radiation oncology at Broward Health, a seven-hospital integrated system in Fort Lauderdale, FL. "But to utilize the technologies properly is very important."