AHE Blog

The Evolving Landscape of U.S. Payer Coverage Decisions: The Role of Health Economics and Outcomes Research

Although there are a large number of public and private payers in the U.S., medical device and pharmaceutical manufacturers generally focus on two types of payers: (1) Medicare, which is administered by the Centers for Medicare and Medicaid Services (CMS) and covers individuals ages ≥ 65; and (2) private commercial payers (e.g., Blue Cross and Blue Shield plans; […]

Will an Unravelling of the Affordable Care Act Result in Meaningful Organizational Changes in U.S. Medical Care? Implications for Economic Evaluation of Drugs & Devices

In recent years, there has been a shift in U.S. health care markets to a broader, population-based perspective when assessing the costs and benefits of medical innovation. Cost effectiveness analysis and budget impact analysis results can look quite different when viewed from the perspective of a health system or an accountable care organization. […]

Value-Based Payment for Oncology Services

Cancer care is a large part of overall health care expenditures. Of the approximately 18% of U.S. gross domestic product spent on healthcare, more than 5% is attributed to cancer treatments.[1] Considering the premature mortality associated with cancer, the humanistic and economic toll is enormous. Consequently, in recent years there has been increasing attention […]

Why Medical Device Companies Need to Develop Economic Evidence in the U.S.

Although the U.S. lacks a centralized health technology evaluation agency, as many of the European countries maintain, in recent years there has been considerable pressure to control the rising costs of new biopharmaceuticals and medical devices.[1-5] After relatively slow growth in the 1960s, U.S. health care expenditures grew intensely in the decades between 1980 and […]

Reference Pricing for in vivo and in vitro Diagnostic Tests

Prices in health care vary widely even within the same local market and for similar tests and treatments. This reflects differences among providers in their ability and willingness to leverage bargaining power against private insurers. For their part, consumers and patients often have been indifferent to price since they have been well covered by insurance. […]

Purchasing Medical Innovation: The Implications for the Medical Device Industry

  In an earlier blog, we reviewed the recent book by one of Avalon’s directors, James Robinson. Robinson’s book, entitled “Purchasing Medical Innovation: The Right Technology, for the Right Patient, at the Right Price” seeks to unpack the often precarious relationships among medical device makers, the purchasers of those devices, the insurers, who are often the […]

Physician Shortages in the U.S.: Disentangling Myth, Folklore, and Fact

Much of the public media and even a substantial part of the medical literature operates on the assumption that there is a shortage of physicians in the U.S., including those specializing in primary care, intensive care, and surgery. One study, for example, estimated that the physician shortfall in the U.S. would reach 90,000 by 2025.[1] […]

Controlling the Costs of Clinical Laboratory Testing in Medical Practice

Today’s clinical laboratory can do much more than you think. Advances in molecular diagnostics, genetics and biomarkers have ushered in a new era of clinical laboratory capabilities. Along with these advances, however, are higher laboratory expenditures. The U.S. Medicare program spent $6.5 billion annually on laboratory in 2006. By 2010, the program was spending $8.2 […]

Fad Diets and Nutrition: What’s all the Fuss about Gluten?

In recent years, the food industry has seen a boom in the “free from” category, including a myriad of ingredients such as high fructose corn syrup, artificial flavors, toxic pesticides, artificial hormones, antibiotics, and GMOs. One such product that has been particularly demonized recently is gluten. Celebrities from Miley Cyrus to former president Bill Clinton […]

Book Review: “Purchasing Medical Innovation: The Right Technology, for the Right Patient, at the Right Price,” by James C. Robinson

The demand for medical care services in the U.S. has long been the envy of other industries. Americans are generally not accustomed to going without, typically despise most non-market forms of rationing, and don’t like government telling them what they can and can’t have. Beneath this culture of consumption lie several layers of public and […]

Integration of Novel Diagnostics into Clinical Practice

Similar to drug and device markets, a critical part of the success of novel diagnostics is educating providers on clinical and therapeutic utility. However, unlike pharmaceutical drugs, the ordering of a diagnostic test does not necessarily imply a change in provider behavior or a change in treatment strategy. It’s a bit like whether a tree […]

'