Rofo 2019; 191(07): 635-642
DOI: 10.1055/a-0838-6253
Review
© Georg Thieme Verlag KG Stuttgart · New York

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Article in several languages: English | deutsch
Carolin Winkelmann
1  Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany
5  Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
,
Thomas Neumann
1  Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany
5  Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
,
Jan Zeidler
2  Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Anne Prenzler
2  Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Bodo Vogt
1  Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany
4  Chair in Health Economics, Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Germany
5  Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
,
Frank K. Wacker
3  Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
5  Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
› Author Affiliations
Further Information

Publication History

27 August 2018

20 December 2018

Publication Date:
14 February 2019 (online)

Abstract

Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects.

Method This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation” for inpatients and “authorization right” for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies.

Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector.

Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures.

Key Points:

  • HTAs should be a basic component of evidence-based radiology.

  • G-BA’s authority implicitly creates a paradox in terms of inventives to implement and finance HTAs.

  • University hospitals and public funding institutions need to support studies that assess the benefit of radiological procedures.

Citation Format

  • Winkelmann C, Neumann T, Zeidler J et al. Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply. Fortschr Röntgenstr 2019; 191: 635 – 642