I've read through the pharmacoeconomic study that Rick provided the link to and it's quite interesting. If you have real money on the line, I'd recommend you read the full thing. In case you're too lazy to do so, I'll give you just one little piece.
On average, 10% of all lumbar surgeries performed each year are reoperations. If ADCON-L was used in the primary surgery, the time needed in surgery for the secondary operation is approximately 74 minutes less (this is statistically significant with p = 0.001). The article translates that into a cost savings - if ADCON-L is used in the primary surgery - of $3,670 by including the cost of support staff and so forth and I think this is a credible number. A surgical theater along with all the necessary support staff is not cheap.
What that means is that the expected *cost* of *not* using ADCON-L in the primary surgery is *at least* $370 (for the mathematically inclined, I know I'm fudging the arithmetic a bit, but the difference is negligible and I'm not about to explain the full expected value calculation). There are other cost savings involved, but I want to do this conservatively.
Thus, based solely on a reduction in expected reoperation times, a health insurer should be willing to pay up to $370 for one application of ADCON-L.
This does not count any reduction in the frequency of reoperations just as it doesn't count reduction in pain medication needed, fewer days of work lost and so forth.
I picked this particular number because it's not too difficult to get a handle on. The cost of an operating theater with all necessary staff is a known quantity to an insurance company. They know the exact number they have to pay the hospital per minute.
So what's the cost of a tube of ADCON-L? If it's higher than $370, it's an uphill battle. If not, it's just a matter of slogging through the usual bureaucratic mud.
Incidentally, that whole issue was really about ADCON-L. There aren't any viable alternatives and it's clear from *all* the studies that good surgical technique combined with use of ADCON-L as a *prophylactic* does improve the expected outcome for the patient. And if it doesn't cost too much, it does cut costs for the insurance company.
The studies also provide some interesting pictures. It's very clear that ADCON-L acts as a barrier for fibroblasts without having any apparent cell toxicity. That's good news for other ADCON indications.
Anyone know what a tube of ADCON-L costs?
If you're serious about investing in this issue, *read* the full issue of Neurological Research. All you need to get through it is basic cell biology and some mathematics. At worst, you'll miss some of the detailed surgery discussions, but you'll at least get a good feel for the whole epidural fibrosis issue.
Thanks, Torben |
