1. Medical tools for the future: Cost-effective solutions based on advanced technologies L. Enrique SucarINAOE M é xico Panel on Health Informatics Los Retos de la Era de la Informaci ó n UNAM 2011

2. Outline Cost-effectiveness analysis Low-cost technologies Examples: –Markov model for the Human Papiloma virus vaccine –Low-cost system for stroke rehabilitation Conclusions

3. Introduction The cost of medical attention has increased in a significant way in the last decades An important part of these costs has to do with the tools used for diagnosis and therapy, such as medical imaging, therapeutic robots, …

4. Introduction These excessive costs limit the access to high quality medical treatment, in particular in developing countries They also have an important impact on the increasing costs of medical insurance In some cases, the potential benefits of a therapy is limited due to the high costs, such as in stroke rehabilitation

5. Introduction We focus on two strategies to reduce the cost of medical attention, maintaining the same quality: –The use of decision-theoretic tools for cost- effectiveness analysis –The development of low cost alternatives based on advanced technologies, in particular information technologies

6. Cost-effectiveness analysis In general, the effectiveness of alternative medical treatments, drugs, etc., are evaluated in controlled clinical trails However, the cost aspect is usually not considered In many cases, there are alternative solutions that provide similar clinical results, but are more cost-effective

7. Cost-effectiveness analysis Governments, and medical institutions in general, should take into account the cost-effectiveness of the different medical alternatives to optimize the resources and provide the best medical treatment to all the population Decision-theoretic computational models, such as Markov models, provide the tools to perform a cost-effectiveness analysis of the different medical strategies

8. Decision-Theoretical Models The different factors, decisions and cost/utilities are represented within a computational model (based on probability and decision theory) which provides a cost-effectiveness analysis, and helps to take the best decisions under uncertainty Using these tools, decision makers can analyze and compare alternative medical treatments and strategies to select the optimal policies

9. Example 1 A Markov model for the cost- effectiveness analysis of the Human Papiloma virus vaccine

10. Motivation There is an increasing pressure to implement a comprehensive program of vaccination for the Human Papiloma virus However there is no conclusive evidence on the effectiveness of the vaccine, and the cost of an extensive vaccination campaign is quite high Thus, it is important to evaluate objectively the cost-effectiveness of the Papiloma vaccine

11. A preliminary Markov model

12. Low Cost Technology For several medical specialties technology is critical for diagnosis and treatment Many medical technologies are very expensive, this limits their access in particular for small clinics and public institutions In many cases it is possible to develop alternative technologies that can provide similar results at a significant lower cost

13. Example 2 Low cost alternative for upper extremities rehabilitation after stroke

14. Motivation Many people suffer strokes (15 million worldwide per year) 80% lose arm and hand movement skills Physical and occupational therapy can help, but: –Expensive (requires a therapist) –Usually not enough –Patients loose motivation Robotic systems are too expensive for use at home or small clinics

15. Gesture Therapy Simulated environment Monocular tracker Gripper Trunk compensation detection

16. Clinical Study INNN rehabilitation unit, Mexico City

17. Discussion The clinical impact of GT is at least as good as conventional occupational therapy and rehabilitation robots Patients show a stronger motivation and attachment to the treatment It has the potential of being used at home without the need of an always present therapist

18. Conclusions Decision theoretic models provide the tools to analyze the cost-effectiveness of alternative medical policies Information technologies can be used to develop low-cost medical solutions Both are important to develop the medical tools for the future

19. Thank you! esucar@inaoep.mx