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Prescriptions Blog: Researchers Question Coverage for a Spine Procedure PDF Print E-mail

What happens when a medical treatment is not found to clearly benefit patients? The answer may depend on whether the barn door is already wide open, according to a new analysis that reviews the history of a common spine procedure that was shown to be of unclear value long after Medicare and other insurers chose to pay for it.

In the article, published Monday in Health Affairs, researchers at Johns Hopkins and the National Institutes of Health looked at percutaneous vertebroplasty, a popular method of treating fractures of the vertebrae by injecting bone cement in the spine. Medicare began covering the treatment in 2001, and eight years later, the results of two published clinical studies indicated the surgery was no better in relieving pain than a placebo. While the surgery might help some patients, the research called into question its broad use.

After the studies appeared, there was much hue and cry from the doctors, and a couple of insurers thought about withdrawing coverage, only to change their minds. As the authors put it, “early coverage before rigorous randomized trials, or ‘opening Pandora’s box,’ as one payer characterized it, tilted the scale against the possibility that payers could or would choose to change coverage for vertebroplasty, even in the face of negative evidence.”

The authors recommend that insurers, including Medicare, work harder to demand better evidence from doctors and device makers about whether a new treatment is effective before they decide to pay for it. As long as medical procedures can receive “broad insurance coverage without rigorous evidence of benefit, the vertebroplasty story is likely to be repeated,” they argued.

They also recommended that insurers consider changing the way they pay doctors so they do not have a financial incentive to favor one treatment over another, especially in the absence of strong evidence that the more lucrative treatment is better for patients.

Health Affairs is making the study available online without charge for two weeks.

The authors are Katharine Cooper Wulff, a Sommer Scholar in the master of public health program at Johns Hopkins; Franklin G. Miller, a researcher at the National Institutes of Health; and Dr. Steven D. Pearson, president of the Institute for Clinical and Economic Review at Massachusetts General Hospital.

Read more http://feeds.nytimes.com/click.phdo?i=13cd1e05592ca0c010876cd4b7d8a8ff