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On Friday, 31 Jan 1997 15:05:40 schlosser.-a-.ciit.org (Paul M. Schlosser)
wrote on the Subject: Re: Pharmacokinetic Imaging
>>PharmPK - Discussions about Pharmacokinetics
>>>3) All high powered MR techniques need justification for
>>>implimentation as a clinical tool. This justification has to include
>>>the relative improvement in patient care over other available
>>>techniques and the proof that the technique will influence the
>>>patient's outcome.
>>
>>I agree. If you look at our poster E4, you will see that the association
>>between trapping and response is rather good (p<.000001). Hence, this is a
>>method that could (and should) be used NOW to select proper patient
>>management.
>Hi all,
>
>Newby here. It seems to me, the question should be: is the improvement
>enough to justify the additional costs to the patient?
>
>-Paul
>schlosser.aaa.ciit.org
Paul:
You raise an important question, one that applies to many technologies. How do
you define expense? Only out of pocket costs? What is the expense (emotional,
physical, economic) of undergoing the wrong or inappropriate treatment? With
that argument, why do a CT or an MRI, when one could do a planar X-Ray, or
even a simple physical! Or put in another manner: "You get what you pay for".
The analysis that needs to be done is what is the cost-benefit ratio to the
system, not just as isolated procedure. To the patient, to the payer, and
to the providers. It is only when we can look at the whole system that we
can define the benefits (or absence thereof) of any procedure.
Thank you for your comments. That is what this bulletin board is all about.
=========================================================================| Professor Walter Wolf, Ph.D. E-Mail: wwolfw.at.hsc.usc.edu |
| Director, Pharmacokinetic Imaging Program |
| Department of Pharmaceutical Sciences Telephone: 213-342-1405 |
| University of Southern California Fax: 213-342-9804 |
| 1985 Zonal Ave., Los Angeles, CA 90033 |
| |
| Center for Noninvasive Pharmacology, Los Angeles Oncologic Institute |
| MRI at St. Vincent Medical Center Telephone: 213-484-7235 |
| 2131 Third St., Los Angeles, CA 90057 Fax: 213-484-7447 |
========================================================================------------------------------
Date: Mon, 3 Feb 1997 12:00:34 -0600
From: MSSilver
Subject: Re: Pharmacokinetic Imaging
Paul M. Schlosser by way of David_Bourne wrote:
>
> PharmPK - Discussions about Pharmacokinetics
> Pharmacodynamics and related topics
>
> >PharmPK - Discussions about Pharmacokinetics
> >>3) All high powered MR techniques need justification for
> >>implimentation as a clinical tool. This justification has to include
> >>the relative improvement in patient care over other available
> >>techniques and the proof that the technique will influence the
> >>patient's outcome.
> >
> >I agree. If you look at our poster E4, you will see that the association
> >between trapping and response is rather good (p<.000001). Hence, this is a
> >method that could (and should) be used NOW to select proper patient
> >management.
>
> Hi all,
>
> Newby here. It seems to me, the question should be: is the improvement
> enough to justify the additional costs to the patient?
>
> -Paul
> schlosser.at.ciit.org
>
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> Paul M. Schlosser, Ph.D.
> Chemical Industry Institute of Toxicology (CIIT)
> P.O. Box 12137
> 6 Davis Drive (not needed for regular mail)
> Research Triangle Park, NC 27709
> Voice:(919) 558-1243; FAX:(919) 558-1300; schlosser.-a-.ciit.org
>
> Dear Dr. Schlosser:
If I may attempt to answer your question, the answer is it depends on
several factors. First, if in the case of chemotherapy from the
patient's viewpoint, if MR spectroscopy can prospectively rule out a
therapy from consideration, saving the patient time in ineffective
therapy, then MRS becomes cost effective.
A similar argument can be made for the case of the pharmaceutical
development. Where drug development from concept to registration is
approx. $300 Million, a non-invasive technique that permits the analysis
of pharmacokinetics at the target tissue can, as Dr. Wolf
demonstrated, provide important information during clinical trials
that can help pharmaceutical companies improve their data quality and
increase their chances for success.
Yours truly,
Michael Silver
Back to the Top
>>>Hence, this is a method that could (and should) be used NOW to select
>>>proper patient management.
>
>>Newby here. It seems to me, the question should be: is the improvement
>>enough to justify the additional costs to the patient?
>>
>>-Paul
>
>Paul:
>
>You raise an important question, one that applies to many technologies. How do
>you define expense? [snip]
>
>The analysis that needs to be done is what is the cost-benefit ratio to the
>system, not just as isolated procedure. To the patient, to the payer, and
>to the providers. It is only when we can look at the whole system that we
>can define the benefits (or absence thereof) of any procedure.
>
>| Professor Walter Wolf, Ph.D. E-Mail: wwolfw.-at-.hsc.usc.edu |
Agreed. I've been holding a debate with someone in the environmental
justice movement about the uses of risk assessment to decide how much should
be spent on environmental clean-ups/waste control technology. She argues
strongly that what is of benefit "to the system" may have a disproportionately
adverse impact on low-income communities. This is a tough issue. I'm coming
to the conclusion that "we" must balance "the needs of the many" against the
"needs of the few" (watching too much ST lately) with neither taking complete
precedence.
But in this case I presume it would be more feasible to evaluate how many
mis-diagnosis could be avoided with the new technology, and so what the
costs of including it or not in a health management plan is, relative to
what's already there (ie, the machine that's already paid for).
-Paul
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Paul M. Schlosser, Ph.D.
Chemical Industry Institute of Toxicology (CIIT)
P.O. Box 12137
6 Davis Drive (not needed for regular mail)
Research Triangle Park, NC 27709
Voice:(919) 558-1243; FAX:(919) 558-1300; schlosser.aaa.ciit.org
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