Journal of the American College of Radiology
Volume 7, Issue 8 , Pages 603-613, August 2010

Addressing “Waste” in Diagnostic Imaging: Some Implications of Comparative Effectiveness Research

  • Adam G. Elshaug, MPH, PhD

      Affiliations

    • Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
    • Adelaide Health Technology Assessment, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
    • The Hanson Institute, Institute of Medical and Veterinary Science, Adelaide, Australia
    • Corresponding Author InformationCorresponding author and reprints: Adam G. Elshaug, BA, BSc(Hons), MPH, PhD, Level 3, 122 Frome Street (DX 650 545), The University of Adelaide, Adelaide, South Australia, 5005, Australia
    • ,
  • Taryn Bessen, MBBS, FRANZCR

      Affiliations

    • Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
    • Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, Australia
    • ,
  • John R. Moss, MSocSci, BEc, MBBS

      Affiliations

    • Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
    • ,
  • Janet E. Hiller, BA, DipSocStudies, MPH, PhD

      Affiliations

    • Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
    • Adelaide Health Technology Assessment, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia
    • The Hanson Institute, Institute of Medical and Veterinary Science, Adelaide, Australia

Comparative effectiveness research is intended to provide evidence to improve patient outcomes through the use of the most appropriate health technology affordable. The authors present 5 case studies, focusing on the use of plain radiography in common clinical scenarios, to illustrate the considerable scope for comparative effectiveness research within medical imaging and the different levels of evidence currently in existence to guide the improved use of medical imaging. These are blunt ankle injury, breast cancer follow-up, low back pain, routine daily chest x-rays in intensive care, and screening for breast cancer. Although there are established models for evaluating new technologies, especially pharmaceuticals, against the most commonly used current technology, the evaluation of technologies in current clinical practice is in an early phase of development. Because evaluation resources are limited, one major challenge is developing ways to identify established technologies for evaluation to refine the indications for their use. A set of criteria with which to identify established technologies that may not be delivering value for money is described, and their use is illustrated in relation to the 5 case studies. These criteria could be incorporated into literature search strategies, stakeholder consultations, and utilization scanning. Once identified, these technologies should be formally evaluated for their performance in improving patient health without restricting the availability of other effective interventions.

Key Words: Diagnostic imaging, comparative effectiveness research, disinvestment, cost effectiveness, evidence based medicine

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 The first two authors contributed equally to this article.

 Dr Elshaug is supported by a Hanson Institute Research Fellowship from the Institute of Medical and Veterinary Science (Adelaide, Australia). Professor Hiller, Dr Elshaug, and Associate Professor Moss are chief investigators on Australian National Health and Medical Research Council Project Grant 565327, which focuses on comparative effectiveness research and disinvestment. Professor Hiller is director and Dr Elshaug is a fellow of Adelaide Health Technology Assessment, which is contracted to complete evaluations of health technologies. Associate Professor Moss provides health technology assessments to the Australian government as a consultant.

PII: S1546-1440(10)00151-1

doi:10.1016/j.jacr.2010.03.010

Journal of the American College of Radiology
Volume 7, Issue 8 , Pages 603-613, August 2010

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