In Washington State: It's Non Nice, Only It's Good.

Back inward 2006, the solid pose down of Washington enacted a police line creating the Washington State Health Technology Assessment Program. Since 2007, the state's Health Care Authority has administered a Health Technology Clinical Committee (HTCC)--composed of 11 independent wellness tending professionals who review data in addition to homecoming decisions at opened upwards populace meetings. They determine whether in addition to how selected wellness technologies (medical in addition to surgical devices in addition to procedures, medical equipment, in addition to diagnostic tests) are covered past times several solid pose down agencies. Participating solid pose down agencies include the Health Care Authority; Department of Social in addition to Health Services (Medicaid); Labor in addition to Industries; Department of Corrections; in addition to Department of Veterans Affairs. In some respects, the plan is analogous to the United Kingdom's National Institute for Health in addition to Care Excellence (NICE), which performs like functions for the National Health Service.

The means sets forth the next problem statement:

New innovations inward medicine, fifty-fifty inward the lastly 10 years, get got improved the wellness in addition to lives of patients, notwithstanding they get got come upwards at a high toll inward price of health, safety, in addition to affordability. Health tending spending in addition to costs are ascension dramatically, simply patients inward the U.S. of A. of America are non getting healthier nor using wellness tending that is available, recommended, in addition to proven to work. Medical products in addition to treatments are introduced without independent, scientific evidence well-nigh whether they are safe, effective, in addition to render benefits that are improve than existing alternatives. The data historic menstruation has compounded the occupation – at that spot is a overflowing of information, simply doctors in addition to patients don’t get got the tools or the fourth dimension to form through it all.

It engages inward this process:

[Chosen] engineering scientific discipline topics volition live posted for 30 (30) days to get together populace comment. An impartial query firm, called a Technology Assessment Center, volition in addition to thence comport a review of the evidence well-nigh safety, effectiveness, in addition to toll comparisons in addition to write a written report that summarizes the evidence in addition to the methods used to analyze it. These assessment reports typically accept betwixt ii in addition to half dozen months to complete. Once the written report has been completed, it is given to the Health Technology Clinical Committee. The clinicians on the commission volition utilization the evidence written report to create upwards one's heed whether the engineering scientific discipline is shown to live condom in addition to effective; whether Washington solid pose down agencies volition pay for the technology; in addition to nether what circumstances. The initial review in addition to determination physical care for volition accept betwixt half dozen in addition to twelve months, in addition to technologies volition live considered for re-review at to the lowest degree every 18 months.

So what did the HTCC conclude well-nigh proton beam therapy?  They unanimously decided that its utilization should live restricted to clinically appropriate cases, based on the best available scientific evidence.

Proton Beam Therapy is a covered create goodness amongst conditions for: Ocular cancers; Pediatric cancers (e.g., medulloblastoma, retinoblastoma, Ewing’s sarcoma); Central nervous organisation tumors; Other non-metastatic cancers amongst the next conditions: Patient has had prior radiations inward the expected handling champaign amongst contraindication to all other forms of therapy; in addition to at means discretion.

Proton Beam Therapy is not covered for all other conditions.

Well, hither nosotros go.  One state, at least, has the feel to mandate that clinical effectiveness analyses accept house in addition to the spine to accept on the medical-industrial-hospital complex inward disapproving clinically unsupported uses of a high-cost technology.

At the national level, it's some other story, equally noted inward this 2014 Modern Healthcare article past times Jaimy Lee:

The CMS hasn't issued a national coverage determination for proton-beam therapy. All local Medicare contractors get got approved paying for the treatment.

In a 2013 Brookings Institution paper, [Amitabh] Chandra wrote that the willingness of Medicare to encompass the average full toll of proton-beam therapy is incentivizing hospitals to cook centers that toll hundreds of millions of dollars in addition to also to “run through equally many prostate cancer patients equally possible to pay off the bonds.” Other policy experts, writing inward the New York Times' persuasion page, called proton-beam therapy “crazy medicine in addition to unsustainable populace policy.” 

(Note:  Thanks to @pash22 on Twitter for the Pb on this story.)

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