1. The Other Side of Health Care Costs: Is improved technology making a difference? Health care costs have increased dramatically over the past decade - largely due to technological improvements What have we gained from this additional spending? Examples presented: ‘Heart Disease ‘Gallbladder Surgery ‘Knee Replacement ‘Cancer Washington State Hospital AssociationHealth Information Program Introduction

2. Heart Disease Washington State Hospital AssociationHealth Information Program 1960’s: Coronary Artery Bypass Grafting (CABG) 1970’s: Angioplasty 1990’s: Coronary Stenting combined with angioplasty 1960-present: improved pharmaceutical management Technological Advances:

3. Heart Disease Washington State Hospital AssociationHealth Information Program Treatment Trends in WA state Advanced technology is being increasingly utilized to treat heart disease in Washington State Source: Comprehensive Hospital Abstract Reporting System, Washington State Department of Health 1987-2001

4. Heart Disease Washington State Hospital AssociationHealth Information Program Improved Outcomes: People with heart disease are being treated at an earlier age, returning to work faster, and living longer * 2000 Comprehensive Hospital Abstract Reporting System (CHARS) Database of Washington State Department of Health. ** Hlatky MA, Boothroyd D, Horine S, et al. Employment after coronary angioplasty or coronary bypass surgery in patients employed at the time of revascularization. Ann Intern Med. 1998 Oct 1;129(7):543-7. *** Cutler, DM, McClellan, M, Is technological change in medicine worth it? Health Aff (Millwood). 2001 Sep-Oct;20(5):11-29.

5. Heart Disease Washington State Hospital AssociationHealth Information Program “We estimate that the value of improved health is greater than the increased cost of heart attack care, so that the cost of living for people with a heart attack is falling. “While we pay more for medical care than we used to...it is hard to escape the conclusion that the additional spending on heart attacks has been worth the cost” Conclusions: Benefits appear to outweigh additional costs of improved procedures for heart disease -- Cutler DM, McClellan M, Newhouse J. The Costs and Benefits of Intensive Treatment for Cardiovascular Disease. National Bureau of Economic Research Working Paper No.w6514. April 1998.

6. Gallbladder Surgery Washington State Hospital AssociationHealth Information Program Technological Advances: Traditional Open Surgery 5-8” incision through abdominal wall muscles Laparoscopic Surgery 4 tiny incisions to insert surgical instruments and miniature video camera

7. Gallbladder Surgery Washington State Hospital AssociationHealth Information Program Improved Outcomes: Laparoscopic gallbladder surgery has led to shorter hospital stay, faster return to work, and less incision pain and scarring *Healthcommunities.com, Surgery Channel, “Cholecystectomy”. http://www.surgerychannel.com/cholecystectomy/preop.shtml#post http://www.surgerychannel.com/cholecystectomy/preop.shtml#post **Glavic Z, Begic L, Simlesa D, Rukavina A. Treatment of acute cholecystitis: A comparison of open vs laparoscopic cholecystectomy. Surg Endosc 2001 Apr; 15(4):398- 401

8. Knee Replacement Washington State Hospital AssociationHealth Information Program Total Knee Replacement: All articulating surfaces of the knee joint are replaced with synthetic prosthesis Partial Knee Replacement: Only a portion of the knee joint is replaced Minimally Invasive Partial Knee Replacement: A partial knee replacement done with a smaller incision to reduce post-operative pain and improve the recovery period “Of those individuals who require knee replacement surgery, about 30-40%...can benefit from a [partial] knee replacement” -- The Rush Arthritis and Orthopedics Institute Technological Advances:

9. Knee Replacement Washington State Hospital AssociationHealth Information Program Improved Outcomes: Minimally invasive partial knee replacement has a shorter hospital stay, faster return to walking, and less incision pain and scarring Source: University of Washington Department of Orthopaedics and Sports Medicine. “Minimally-Invasive Knee Replacement” Edited by Seth S. Leopold, M.D. http://www.orthop.washington.edu/faculty/Leopold/miniknee/print http://www.orthop.washington.edu/faculty/Leopold/miniknee/print

10. Cancer Washington State Hospital AssociationHealth Information Program Technological Advances: Death Rate* Cancer death rates have been falling by >1%/yr since 1993 - the first sustained decline since death recording began in the 1930’s Incidence Rate* The rate of new cancers, for all cancers combined was stable during most of the 1990s, after increasing during the 1970’s through 1980’s Change most likely due to better prevention, screening, and treatment of cancer “The continuing decline in the rate of cancer deaths once again affirms the progress we’ve made against cancer…” - Andrew von Eschenback MD, Director of the National Cancer Institute Improved prevention, screening, and treatment of cancer has led to lower death rates and stabilized incidence rates * National Institute of Diabetes & Digestive & Kidney Diseases, NIH Publication No. 02-2897, March 2002.

11. Cancer Washington State Hospital AssociationHealth Information Program Five-year cancer survival rates have been steadily increasing over the past two decades Trends in 5-year Survival Rate Percentages: Source: American Cancer Society. Cancer Facts and Figures 2002

12. Cancer Washington State Hospital AssociationHealth Information Program Improved treatments & better quality of life: Breast Cancer Treatments Radical Mastectomy Breast Conservation Surgery Chemo- therapy Radiation Therapy Hormonal Therapy 1970’s 2002 Improved technology in breast cancer has led to less invasive treatments, better outcomes, and improved quality of life.