Cost-Effectiveness Drives Generation Of Choosing Wisely Initiative
By Christine Kern, contributing writer
Practices or products with demonstrated cost-effectiveness make the grade according to Choosing Wisely
According to an analysis published in JAMA, good cost-effectiveness data will secure a product or practice’s spot on a best practices list. The study found that the proliferation of lists tends to exclude information on new or experimental treatments, focusing on those that have documented and repeated successes.
Researchers think revision of the criteria for the lists is necessary. Currently, these lists are done as part of the Choosing Wisely campaign of the ABIM Foundation.
ABIM focuses on healthcare improvement, and launched the campaign in April, 2012. The campaign works in collaboration with various specialty societies to generate best practice lists to aid physicians and patients in making more efficient choices about healthcare services by reducing unnecessary testing or procedures and more effective lines of treatment.
National Institutes of Health researchers examined 135 “top five lists” generated by 25 specialty societies as of August 2013. The project wanted to gauge the selection factors of a list-worthy treatment or procedure.
ModernHealthcare reports roughly 76 percent, or 102 of the lists, were included because the societies had adequate evidence to demonstrate that a treatment or procedure had no additional benefits to justify higher risks or costs, compared with other options. Of the 25 specialty societies, 60 percent had at least one service whose inclusion was justified by costs.
Dr. Steven Pearson of the National Institutes of Health and a co-author of the research letter asserts, “It's a good place to start.” But even though he supports the lists, he stated while it makes sense the emphasis in the first couple of years has been on topics where the evidence is strong, “Over time they may want to broaden their reach and look at more emerging techniques.”
Pearson also said that the selection process should be clearer and more consistent for the top-five lists, and the analysis contends that confidence in the results could increase if they provided clear definitions of potentially wasteful medical care and clearer justifications for the services.
Authors of a previous editorial published in JAMA expressed concerns over the development of top-five lists, saying most did not provide detailed methods and that there appeared to be little input from frontline practitioners.
Nearly 50 groups, including the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Cardiology and the American College of Emergency Physicians, are listed on the ABIM website as having generated at least one list.