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

References 

  1. Institute of Medicine. Initial national priorities for comparative effectiveness research. Washington, DC: National Academies Press; 2009;
  2. House of Commons Health Committee. National Institute for Health and Clinical Excellence: first report of session 2007-08. Volume 1 London: Her Majesty's Stationery Office; 2008;
  3. Australian Government. Budget paper no 2, 2009-10 (Part 2: expense measures—health and ageing). http://www.budget.gov.au/2009-10/content/bp2/html/bp2_expense-16.htmAccessed November 16, 2009
  4. Australian Government, Department of Health and Ageing. Health technology assessment review: discussion paper 5—enhanced post market surveillance (proposal 16). http://www.health.gov.au/internet/main/publishing.nsf/Content/htareview_discussion_paper5Accessed November 16, 2009
  5. Elshaug AG, Hiller JE, Tunis SR, Moss JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust N Z Health Policy. 2007;4:23
  6. Elshaug AG, Hiller JE, Moss JR. Exploring policy-makers' perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 2008;24:1–9
  7. Daniels S, Ramey M. The leader's guide to hospital case management. Sudbury, Mass: Jones Bartlett; 2005;
  8. Hoffman A, Pearson SD. “Marginal medicine”: targeting comparative effectiveness research to reduce waste. Health Aff (Millwood). 2009;28:w710–w718
  9. Fuchs VR, Emanuel EJ. The perfect storm of overutilization. JAMA. 2008;299:2789–2791
  10. Fuchs V. Eliminating “waste” in health care. JAMA. 2009;302:2481–2482
  11. Stiell IG, McKnight RD, Greenberg GH, et al. Implementation of the Ottawa ankle rules. JAMA. 1994;271:827–832
  12. Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA. 1993;269:1127–1132
  13. Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326:417
  14. Dowling S, Spooner CH, Liang Y, et al. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med. 2009;16:277–287
  15. Brehaut JC, Stiell IG, Visentin L, Graham ID. Clinical decision rules “in the real world”: how a widely disseminated rule is used in everyday practice. Acad Emerg Med. 2005;12:948–956
  16. Bessen T, Clark R, Shakib S, Hughes G. A multifaceted strategy for implementation of the Ottawa ankle rules in two emergency departments. BMJ. 2009;339:b3056
  17. National Institute for Health and Clinical Excellence. Head injury. London, United Kingdom: National Institute for Health and Clinical Excellence; 2007;
  18. Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001;357:1391–1396
  19. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med. 1992;21:1454–1460
  20. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286:1841–1848
  21. Kline JA, Wells PS. Methodology for a rapid protocol to rule out pulmonary embolism in the emergency department. Ann Emerg Med. 2003;42:266–275
  22. Wells PS, Anderson DR, Bormanis J, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350:1795–1798
  23. Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26:405–413
  24. National Institute for Health and Clinical Excellence. Early and locally advanced breast cancer: diagnosis and treatment. Cardiff, United Kingdom: National Collaborating Centre for Cancer; 2009;
  25. Lu W, Jansen L, Post W, Bonnema J, Van de Velde JC, De Bock GH. Impact on survival of early detection of isolated breast recurrences after the primary treatment for breast cancer: a meta-analysis. Breast Cancer Res Treat. 2009;114:403–412
  26. Scottish Intercollegiate Guidelines Network. Management of breast cancer in women (A national clinical guideline). Edinburgh, United Kingdom: Scottish Intercollegiate Guidelines Network; 2005;
  27. National Breast Cancer Centre. Breast imaging: a guide for practice. Sydney, Australia: National Breast Cancer Centre; 2002;
  28. Grunfeld E, Dhesy-Thind S, Levine M Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: follow-up after treatment for breast cancer (summary of the 2005 update). CMAJ. 2005;172:1319–1320
  29. Khatcheressian J, Wolff A, Smith T, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24:5091–5097
  30. Montgomery D, Krupa K, Cooke T. Alternative methods of follow up in breast cancer: a systematic review of the literature. Br J Cancer. 2007;96:1625–1632
  31. Gulliford T, Opomo M, Wilson E. Popularity of less frequent follow-up for breast cancer in randomised study: initial findings from the hotline study. BMJ. 1997;314:171–177
  32. Kokko R, Hakama M, Holli K. Follow-up cost of breast cancer patients with localised disease after primary treatment: a randomised trial. Breast Cancer Res Treat. 2005;93:255–260
  33. Paszat L, Sutradhar R, Grunfeld E. Outcomes of surveillance mammography after treatment of primary breast cancer: a population- based case series. Breast Cancer Res Treat. 2009;114:169–178
  34. de Bock G, Bonnema J, van Der Hage J, Kievit J, van de Velde CJ. Effectiveness of routine visits and routine tests in detecting isolated locoregional recurrences after treatment for early stage invasive breast cancer: a meta-analysis and systematic review. J Clin Oncol. 2004;22:4010–4018
  35. Mannino M, Yarnold J. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld?. Radiother Oncol. 2009;90:14–22
  36. Chou R, Fu R, Carrino J, Deyo R. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463–472
  37. National Institute of Clinical Studies. Lumbar imaging in acute non-specific low back pain. Canberra, Australia: National Health and Medical Research Council; 2008;
  38. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478–491
  39. van Tulder M, Becker A, Bekkering T, et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(suppl):S169–S191
  40. Hejblum G, Chalumeau-Lemoine L, Ioos V, et al. Comparison of routine and on-demand prescription of chest radiography in mechanically ventilated adults: a multicentre, cluster-randomised, two-period crossover study. Lancet. 2009;374:1687–1693
  41. Siegel M, Rubinowitz A. Routine daily vs on-demand chest radiographs in intensive care. Lancet. 2009;374:1656–1658
  42. The Cancer Council Australia. National cancer prevention policy 2007-2009 (Section 2: screening to detect cancer early). http://www.cancer.org.au/File/PolicyPublications/NCPP/NCPP07-09breastcancer.pdfAccessed December 28, 2009
  43. The Cancer Council Australia. Position statement: early detection of breast cancer. http://www.cancer.org.au/policy/positionstatements/breastcancer.htmAccessed December 28, 2009
  44. National Health Service. NHS Breast Screening Programme. http://www.cancerscreening.nhs.uk/breastscreen/Accessed December 28, 2009
  45. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716–726
  46. BreastCancer.org. Research news on screening and testing. http://www.breastcancer.org/symptoms/testing/new researchAccessed December 28, 2009
  47. Gotzche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Systc Rev. 2009;4:CD001877
  48. Morrell S, Barratt A, Irwig L, Howard K, Biesheuvel C, Armstrong B. Estimates of overdiagnosis of invasive breast cancer associated with screening mammography. Cancer Causes Control. 2010;21:275–282
  49. Elshaug AG, Moss JR, Littlejohns P, Karnon J, Merlin TL, Hiller JE. Identifying existing health care services that do not provide value for money. Med J Aust. 2009;190:269–273
  50. Gafni A, Birch S. Incremental cost-effectiveness ratios (ICERs): the silence of the lambda. Soc Sci Med. 2006;62:2091–2100
  51. Eckermann S, Willan AR. Expected value of information and decision making in HTA. Health Econ. 2007;16:195–209
  52. Elshaug AG, Watt AM, Moss JR, Hiller JE. Policy perspectives on the obsolescence of health technologies in Canada. http://www.cadth.ca/index.php/en/policy-forum/discussion-papers/policy-perspectives-on-the-obsolescence-of-healthAccessed December 23, 2009
  53. Morgan SG, McMahon M, Mitton C, et al. Centralized drug review processes in Australia, Canada, New Zealand, and the United Kingdom. Health Aff (Millwood). 2006;25:337–347
  54. O'Malley SP. The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998-2004). Aust N Z Health Policy. 2006;3:3

 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

Article Tools