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
Outline
• Cost-effectiveness analysis
• Low-cost technologies
• Examples:
– Markov model for the Human Papiloma virus
vaccine
– Low-cost system for stroke rehabilitation
• Conclusions
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, …
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
Introduction
• We focus on two strategies to reduce the
cost of medical attention, maintaining the
same quality:
– The use of decision-theoretic tools for costeffectiveness analysis
– The development of low cost alternatives based
on advanced technologies, in particular
information technologies
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
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
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
Example 1
A Markov model for the costeffectiveness analysis of the Human
Papiloma virus vaccine
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
A preliminary Markov model
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
Example 2
Low cost alternative for upper
extremities rehabilitation
after stroke
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
Gesture Therapy
•
•
•
•
Simulated environment
Monocular tracker
Gripper
Trunk compensation
detection
Clinical Study
INNN rehabilitation unit, Mexico City
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
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
Thank you!
[email protected]