Tuesday, November 25, 2014

Danish get a pasting

Gary Schwitzer reports on the proliferation of robotic surgery in Denmark, in a publicly financed health care system.  He quotes Frederik Joelving, a Danish journalist:
“What’s interesting is that even though our healthcare system is publicly funded, the development here is largely parallel to what’s been happening in the US: With hospitals competing to take the lead in robotic surgery and using dubious claims to market the technology, it has now become virtually impossible to have an open (let alone traditional laparoscopic) prostatectomy in most parts of the country.
So far, Denmark — a country of 5.5 million — has bought da Vinci equipment for 44 million US$, and the reimbursement for each robotic surgery is between 5000 and 10000 US$ higher than for the traditional approach. What’s more, all except one university-affiliated hospitals have stopped teaching open/laparoscopic prostate surgery. As one of my sources said, What happens when something goes wrong during a robotic surgery and you have to convert?”
Noted Gary:

The global march of the robots continues.


nonlocal MD said...

That's pretty amazing.I wonder who makes those kinds of decisions in Denmark?

Barry Carol said...

Perhaps patients just have a fascination with new technology and perceive that it must be better than the traditional approach even if the data show that surgical outcomes are no better with robots. If robotic surgery costs more but doesn’t deliver more value, patients don’t care as long as someone else is paying. That sounds like an argument for reference pricing for these cases to me.

Fred said...

@nonlocal MD: I'm the journo who wrote the original piece. A large part of it was about exactly the question you raise. The answer is, when it comes to medical devices, regulation is virtually non-existent in Denmark and many other European countries (I guess this is actually true of most countries globally). All you need to market a medical device in the EU is a CE mark. National approval by health regulators is not required. If a doctor at a Danish hospital wants to introduce a new medical technology, he is free to do so as long as he can convince the hospital director it's a good idea. This is, essentially, an informal process. There are no written requirements for cost-effectiveness or clinical evidence. If the price passes a certain threshold, which varies across different regions in Denmark (from about 20000 US$ to 2 million), then the imprimatur of the regional administration is needed, but that is usually a formality.

@Barry Carol: patients don't just start requesting robotic surgery out of the blue. In Denmark, as in the US, there has been a tremendous marketing push by Intuitive, hospitals and doctors. Much of it is one-sided and misleading, as I document in my piece. Patients naturally respond to this marketing, because we tend to trust experts, and because "newer must be better"...

Paul Levy said...

Thanks, Fred!