Medical tools for the future: Cost-effective solutions based on advanced technologies

1. Medical tools for the future:Cost-effective solutions based on advanced technologies L. Enrique Sucar INAOE México Panel on Health Informatics Los Retos de la Era de la Información 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 StudyINNN 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