title: Implications of learning effects for hospital costs of new health technologies: the case of intensity modulated radiation therapy.
abstract: OBJECTIVE
  The impact of learning effects on the variability of costs of new health technologies in a prospective payment system (PPS) through the case of intensity modulated radiation therapy (IMRT) was studied.
  
  
  METHODS
  A series of consecutive patients treated in nine medical centers was enrolled in a prospective study. Direct costs were assessed from the perspective of the healthcare providers. We used a two-level model to explain the variability of costs: patients nested within centers. Learning effects at the center level were considered through a fixed effect (the learning curve slope) and a random effect (the initial cost level). Covariates were introduced to explain the patterns of variation in terms of patient characteristics.
  
  
  RESULTS
  The mean direct cost of IMRT was 5,962 euro (range, 2,414 euro-24,733 euro). Manpower accounted for 53 percent of this cost. Learning effects explained 42 percent of the variance between centers (which was 88 percent of the total variance) and were associated with a substantial decrease in treatment costs. The mean initial treatment direct cost was 6,332 euro in centers with a previous experience of IMRT, whereas it was 14,192 euro in centers implementing IMRT for the first time. Including logistics costs and overhead, the full cost of IMRT was 10,916 euro. Average reimbursement was 6,987 euro.
  
  
  CONCLUSIONS
  Learning effects are a strong confounding factor in the analysis of costs of innovative health technologies involving learning effects. In a PPS, innovative health technology involving learning effects necessitates specific reimbursement mechanisms.
authors.affiliation: Gustave Roussy Institute, Villejuif, France. bonastre@igr.fr
authors.forename: Julia
authors.initials: J
authors.lastname: Bonastre
authors.forename: Eric
authors.initials: E
authors.lastname: Noël
authors.forename: Julie
authors.initials: J
authors.lastname: Chevalier
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Gerard
authors.forename: Dimitri
authors.initials: D
authors.lastname: Lefkopoulos
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.forename: Rene Jean
authors.initials: RJ
authors.lastname: Bensadoun
authors.forename: Gerard
authors.initials: G
authors.lastname: de Pouvourville
mesh_terms: D020811:Biomedical Technology; D004059:Diffusion of Innovation; D005060:Europe; D017721:Hospital Costs; D006801:Humans; D007858:Learning; D011445:Prospective Payment System; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics*