Letter to the editor

Editor, Professor Fletcher's thoughtful editorial on expensive medical technology (Aust Prescr 1994;17:54-5) was an excellent rejoinder to the article on thallium scanning (Aust Prescr 1994;17:57-61). I agree with Professor Fletcher that positron emission tomography may have a limited role in cardiology, but it looks promising in oncology and our evaluation has shown its clinical utility in epilepsy.

I believe, however, that Professor Fletcher's hope that all new technology will be backed by outcome studies is probably unrealistic. For example, to study the cardiovascular outcomes of an intervention procedure would cost a minimum of $30-$40 million. Governments are unlikely to make this money available. The real cost of new technology is, of course, not in its development in teaching hospitals, but in its proliferation elsewhere, particularly in the private sector, where restriction may be an unpalatable political decision.

Colin I. Johnston
Chairman
Division of Medicine
University of Melbourne, Vic.

Author's comment

Professor P.J. Fletcher, the author of the editorial, comments:

I believe Professor Johnston's pessimism concerning the financial viability of appropriate evaluation of expensive technology is unwarranted.

Let us make the assumption that a procedure costs the government $1000. If 10 000 procedures are performed each year, the annual cost to the taxpayer is $10 million. Even on Professor Johnston's rather generous estimate, this will pay for a formal evaluation in 3-4 years.

This is surely a compelling argument that it will be cost effective for the government to insist on proper evaluation of new technology and to fund that evaluation before uncontrolled proliferation contributes to escalating health care costs.