Chapter 09: Departing from Epidemiology and Conducting Cost-Effectiveness Studies

Dr. Elting talks about how her interest in value of care evolved.She sets context by noting that in the 2000s many states began requiring that hospitals report the quality of results, making available data about procedures and surgical outcomes. Dr. Elting was able to look at toxicities that caused death and fees for procedures. She explains that expensive and effective new drugs were available to treat toxicities, but insurance companies were unwilling to cover the cost. She says that she initiated cost effectiveness studies to demonstrate that the more expensive drugs ultimately saved money. Her studies were very successful at convincing payers to change their policies. She then talks about the reactions of her colleagues to her change in research direction.Dr. Elting explains that this research took her away from traditional epidemiology and allowed her to differentiate herself, a fact that was critical to her success.Dr. Elting tells a story about a period when General Internal Medicine didn’t have enough beds because they were filled with patients made too sleepy to function by their anti-toxicity medications.