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Nuclear Magnetic Resonance Imaging Technology: a Clinical, Industrial, and Policy Analysis

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Nuclear Magnetic Resonance Imaging Technology: a Clinical, Industrial, and Policy Analysis Nuclear Magnetic Resonance Imaging Technology: A Clinical, Industrial, and Policy Analysis September 1984 NTIS order #PB85-146207 — HEALTH TECHNOLOGY CASE STUDY 27: Nuclear Magnetic Resonance Imaging Technology A Clinical, Industrial, and Policy Analysis SEPTEMBER 1984 This case study was performed as a part of OTA’s Assessment of Federal Policies and the Medical Devices Industry Prepared for OTA by: Earl P. Steinberg, M. D., M.P.P. Assistant Professor, Johns Hopkins School of Medicine and John Hopkins School of Hygiene and Public Health; Senior Associate, Office of Medical Practice Evaluation; also w/Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine and Alan B. Cohen, Sc.D. Associate Director, Center for Hospital Finance and Management; also w/Assistant Professor of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health f I OTA Case Studies are documents containing information on a specific medical technology or area of application that supplements formal OTA assessments. The material is not normally of as immediate policy interest as that in an OTA Report, nor does it present options for Congress to consider. CONGRESS OF THE UNITED STATES Office of Technology Assessment Washington, D C 20510 Recommended Citation: Health Technology Case Study 27: Nuclear Magnetic Resonance Imaging Technology: A Clinical, Industrial, and Policy Analysis (Washington, DC: U.S. Congress, Office of Tech- nology Assessment, OTA-HCS-27, September 1984). This case study was performed as part of OTA’s assessment of Federal Policies and the Medical Devices Industry. Library of Congress Catalog Card Number 84-601123 For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 Preface Nuclear Magnetic Resonance Imaging Tech- tion (preventive, diagnostic, therapeutic, and nology: A Clinical, Industrial, and Policy Anal- rehabilitative); ysis is Case Study 27 in OTA’s Health Technology examples of types of technologies by physical Case Study Series. This case study has been prepared nature (drugs, devices, and procedures); in connection with OTA’s project on Federal examples of technologies in different stages Policies and the Medical Devices Industry, re- of development and diffusion (new, emerg- quested by the Senate Committee on Labor and ing, and established); Human Resources and endorsed by the Senate examples from different areas of medicine Committee on Veterans’ Affairs. A listing of other (e.g., general medical practice, pediatrics, case studies in the series is included at the end of radiology, and surgery); this preface. examples addressing medical problems that are important because of their high frequen- OTA case studies are designed to fulfill two cy or significant impacts (e. g., cost); functions. The primary purpose is to provide examples of technologies with associated high OTA with specific information that can be used costs either because of high volume (for low- in formin general conclusions regardin broader g g cost technologies) or high individual costs; policy issues. The first 19 cases in the Health Tech- examples that could provide information ma- nology Case Stud Series, for example, were con- y terial relating to the broader policy and meth- ducted in conjunction with OTA’s overall project odological issues being examined in the on The Implications of Cost-Effectiveness Anal- particular overall project; and ysis of Medical Technology. By examining the 19 examples with sufficient scientific literature. cases as a group and looking for common prob- lems or strengths in the techniques of cost-effec- Case studies are either prepared by OTA staff, tiveness or cost-benefit analysis, OTA was able commissioned by OTA and performed under con- to better analyze the potential contribution that tract by experts (generally in academia), or writ- those techniques might make to the management ten by OTA staff on the basis of contractors’ of medical technology and health care costs and papers. quality. OTA subjects each case study to an extensive The second function of the case studies is to review process. Initial drafts of cases are reviewed provide useful information on the specific tech- by OTA staff and by members of the advisory nologies covered. The design and the funding lev- panel to the associated project. For commissioned els of most of the case studies are such that they cases, comments are provided to authors, along should be read primarily in the context of the as- with OTA’s suggestions for revisions. Subsequent sociated overall OTA projects. Nevertheless, in drafts are sent by OTA to numerous experts for many instances, the case studies do represent ex- review and comment. Each case is seen by at least tensive reviews of the literature on the efficacy, 30 reviewers, and sometimes by 80 or more out- safety, and costs of the specific technologies and side reviewers. These individuals may be from as such can stand on their own as a useful contri- relevant Government agencies, professional so- bution to the field. cieties, consumer and public interest groups, med- ical practice, and academic medicine. Academi- Case studies are prepared in some instances be- cians such as economists, sociologists, decision cause they have been specifically requested by analysts, biologists, and so forth, as appropriate, congressional committees and in others because also review the cases. they have been selected through an extensive re- view process involving OTA staff and consulta- Although cases are not statements of official tions with the congressional staffs, advisory panel OTA position, the review process is designed to to the associated overall project, the Health Pro- satisfy OTA’s concern with each case study’s gram Advisory Committee, and other experts in scientific quality and objectivity. During the vari- various fields. Selection criteria were developed ous stages of the review and revision process, to ensure that case studies provide the following: therefore, OTA encourages, and to the extent possible requires, authors to present balanced in- Ž examples of types of technologies by func- formation and recognize divergent points of view. 111,.. Health Technology Case Study Seriesa — . ——. —. .-. —.. ————...— ——— —— . Case Study Case Study Series Case study title; author(s); Series Case study title; author(s); number OTA publication numberb number OTA publication numberb 1 Formal Analysis, Policy Formulation, and End-Stage 14 Cost Benefit/Cost Effectiveness of Medical Renal Disease; Technologies: A Case Study of Orthopedic Joint Richard A. Rettig (OTA-BP-H-9(1)) C Implants; 2 The Feasibility of Economic Evaluation of Judith D. Bentkover and Philip G. Drew Diagnostic Procedures: The Case of CT Scanning; (OTA-BP-H-9(14)) Judith L. Wagner (OTA-BP-H-9(2)) 15 Elective Hysterectomy: Costs, Risks, and Benefits; 3 Screening for Colon Cancer: A Technology Carol Korenbrot, Ann B. Flood, Michael Higgins, Assessment; Noralou Roos, and John P. Bunker David M. Eddy (OTA-BP-H-9(3)) (OTA-BP-H-9(15)) 4 Cost Effectiveness of Automated Multichannel 16 The Costs and Effectiveness of Nurse Practitioners; Chemistry Analyzers; Lauren LeRoy and Sharon Solkowitz Milton C. Weinstein and Laurie A. Pearlman (OTA-BP-H-9(16)) (OTA-BP-H-9(4)) 17 Surgery for Breast Cancer; 5 Periodontal Disease: Assessing the Effectiveness and Karen Schachter Weingrod and Duncan Neuhauser Costs of the Keyes Technique; (OTA-BP-H-9(17)) Richard M. Scheffler and Sheldon Rovin 18 The Efficacy and Cost Effectiveness of (OTA-BP-H-9(5)) Psychotherapy; 6 The Cost Effectiveness of Bone Marrow Transplant Leonard Saxe (Office of Technology Assessment) Therapy and Its Policy Implications; (OTA-BP-H-9(18)) d Stuart O. Schweitzer and C. C. Scalzi 19 Assessment of Four Common X-Ray Procedures; (OTA-BP-H-9(6)) Judith L. Wagner (OTA-BP-H-9(19))e 7 Allocating Costs and Benefits in Disease Prevention 20 Mandatory Passive Restraint Systems in Programs: An Application to Cervical Cancer Automobiles: Issues and Evidence; Screening; Kenneth E. Warner (OTA-BP-H-15(20))f Bryan R. Luce (Office of Technology Assessment) 21 Selected Telecommunications Devices for Hearing- (OTA-BP-H-9(7)) Impaired Persons; 8 The Cost Effectiveness of Upper Gastrointestinal Virginia W. Stern and Martha Ross Redden Endoscopy; (OTA-BP-H-16(21)) g Jonathan A. Showstack and Steven A. Schroeder 22 The Effectiveness and Costs of Alcoholism (OTA-BP-H-9(8)) Treatment; 9 The Artificial Heart: Cost, Risks, and Benefits; Leonard Saxe, Denise Dougherty, Katharine Esty, Deborah P. Lubeck and John P. Bunker and Michelle Fine (OTA-HCS-22) (OTA-BP-H-9(9)) 23 The Safety, Efficacy, and Cost Effectiveness of 10 The Costs and Effectiveness of Neonatal Intensive Therapeutic Apheresis; Care; John C. Langenbrunner (Office of Technology Peter Budetti, Peggy McManus, Nancy Barrand, Assessment) (OTA-HCS-23) and Lu Ann Heinen (OTA-BP-H-9(1O)) 24 Variation in Length of Hospital Stay: Their 11 Benefit and Cost Analysis of Medical Interventions: Relationship to Health Outcomes; The Case of Cimetidine and Peptic Ulcer Disease; Mark R. Chassin (OTA-HCS-24) Harvey V. Fineberg and Laurie A. Pearlman 25 Technology and Learning Disabilities; (OTA-BP-H-9(11)) Candis Cousins and Leonard Duhl (OTA-HCS-25) 12 Assessing Selected Respiratory Therapy Modalities: 26 Assistive Devices for Severe Speech Impairments; Trends and Relative Costs in the Washington, D.C. Judith Randal (Office of Technology Assessment) Area; (OTA-HCS-26) Richard M. Scheffler and Morgan Delaney 27 Nuclear
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