A review undertaken of OECD countries indicates technology is one of the main causes of increased health spending as a proportion of GDP. 79 Innovations such as biopharmaceuticals, implantable materials and devices, surgical aids and diagnostic tools are likely to increase costs of diagnosis and treatment but can then reduce longer term costs of poorly managed care and increased admissions. 80
Technological advances may also increase costs by increasing demand for healthcare, e.g. by expanding the potential treatment group or reducing risks to the extent that a particular procedure becomes more attractive.
There have been significant medical advances in assessment and treatment for CVD, particularly acute CVD. These include improved drug treatments and interventions such as arterial grafts, stents, angiography and angioplasty.
While many new technologies increase up front treatment expenses they can, if used within a cost benefit framework, reduce long term costs associated with increased morbidity or higher level interventions. There is a risk that new technologies are adopted without adequate assessment of evidence and used in situations where they do not significantly contribute to improved outcomes.
The development and maintenance of an ongoing evidence base is critical to support sound decisionmaking around prioritised investment in new technologies. 81 82
The value of new drug treatments for specific conditions must likewise be balanced against cost and compared with the effectiveness of existing treatments.
The cost of drugs to treat cardiovascular disease is increasing out of proportion to the overall cost of care. While overall expenditure on cardiovascular disease increased by 18% between 2000-01 and 2004-05, the cost of prescription pharmaceuticals increased by 21%.
As noted in Figure 2 below, prescription pharmaceuticals are the next most expensive sector, after acute care, for cardiovascular disease, with per person expenditure increasing with age. 83 As with technologies, the cost of using more expensive drug treatments now should be balanced against the longer term costs of increased morbidity.
Figure 2: Health care expenditure on cardiovascular disease, by area of expenditure, 2004-05 ($ million)
Source: Australian Institute of Health and Welfare 2008. Health care expenditure on cardiovascular diseases 2004–05. Cardiovascular disease series no. 30. Cat. no. CVD 43. Canberra: AIHW.
Data from image shown above:
Health care expenditure on cardiovascular disease, by area of expenditure, 2004-05 ($million)
- Hospital-admitted patients - 3009
- Prescription pharmaceuticals - 1636
- Out-of-hospital medical services - 1133
- Research - 164
5.4.1 Telehealth and remote monitoringRemote monitoring and self-monitoring of patients with chronic conditions appears to be a significant factor in self-management strategies and in reducing exacerbations and hospitalisation. Most nations are attempting some form of remote care. In the UK, the NHS has installed simple-to-use biometric equipment in patients’ homes, so they can monitor their own blood pressure, blood sugar and blood oxygen levels and avoid unnecessary hospitalisation.
Canadian provinces have utilised Telehealth strategies to fulfil a commitment to improve 24 hour 7 day a week access to primary health care for its populations. The New Brunswick Extra-Mural Program (Canada) has piloted and is rolling out the use of technology to remotely monitor patients with chronic conditions. Patients use a portable device to monitor specific indicators, such as blood pressure, weight and oxygen levels. Once a day this information is sent remotely to a nurse who then follows up if there are concerns. The pilot for this program resulted in 85% fewer admissions in the pilot population and 55% fewer emergency department visits. 84
In NSW, the Home Telecare system was piloted in a rural and a metropolitan centre. 85 The system monitors physical signs, provides medication reminders, a daily log and health promotion information. The article referenced notes that the system was received well by consumers and examples were provided of cases where it led to avoidance of hospital admission.
Initially Telehealth in Australia was primarily a means by which remote and isolated rural communities could receive access to clinical care. It continues to fulfil this important function; however it has as much applicability in the metropolitan context for supporting home-based care.
79 Docteur E & Oxley H, Health Care Systems: Lessons from the reform experience, OECD Health Working Paper, 2003, Directorate for Employment, Labour and National Affairs, France
80 Adelaide Health Technology Assessment National Horizon Scanning Unit, Emerging Technology Bulletin, February 2007
81 Scott, I., Why we need a national registry in interventional cardiology, MJA, Vol 189, No. 4, August 2008.
82 Tonkin, A., Why Australia Needs a Cardiac Procedures Database, Heart, Lung and Circulation, 10 (Suppl), 2001.
83 Australian Institute of Health and Welfare 2008. Health care expenditure on cardiovascular diseases 2004–05. Cardiovascular disease series no. 30. Cat. no. CVD 43. Canberra: AIHW
84 Health Council of Canada, Fixing the Foundation: An Update on Primary Health Care and Home Care Renewal in Canada, January 2008
85 Celler B, Lovell N, Basilakis J, Using information technonlogy to improve the management of chronic disease, MJA, Vol 179, 2003.