New medical innovations are hitting American healthcare just about daily, and several more jaw-dropping technologies might be just a few months away.
Here’s a look at a few of them.
Liquid Biopsy-Cancer Screening
Every year, 1.6 million cancer cases are diagnosed; tragically, 600,000 will die of the disease.
Until now, the standard of diagnosis was a tissue biopsy, which can be costly and painful for the patient. Liquid biopsy uses protein biomarkers in the blood associated with cancer or DNA mutations. It’s quick and easy to administer, and can be performed in just about any clinical setting.
In addition to being a much easier test for the patient, liquid biopsy offers the potential of finding cancer at an early stage, before it’s visible with an imaging technology. This early detection offers the promise of improved outcomes and can be used to help determine whether a treatment plan is working.
Liquid biopsy technologies are being developed to identify multiple cancers such as breast, lung, liver, prostate, ovarian, kidney, thyroid, head, and neck. Studies have shown that using blood for biomarker detection reflects specificity in the 99 to 100 percent range in multiple tests.
Late last year, the FDA approved the cobas EGFR Mutation Test v2 from Roche Molecular Systems, Inc. to detect metastatic non-small cell lung cancer. It is also being used to determine whether a cancer patient is a candidate for treatment with Tarceva (Erlotinib). (Studies have indicated improved outcomes when Erlotinib was prescribed in the treatment plan.)
One potential challenge with a blood test is determining the treatment path if the test is positive for cancer, but a tumor is not visible with x–ray, ultrasound, or MRI. Some cancers may take years to develop into a tumor. This does not allow for a targeted surgical intervention or radiation therapy.
Reimbursement for diagnostic biomarker laboratory testing is based on the process and how many markers or gene mutations are being identified. Reimbursement for existing tests in this category range from $200 to $500. In comparison, x-rays start at $100, ultrasound $250, and MRI $950, under Medicare.
Although these numbers appear to be attractive, the bottom line is that the margins from providing the test will depend on payor reimbursement. The real financial incentives for providers will be realized in an increase in cancer imaging. For payors, early detection of cancer will offer the promise of lower treatment costs.
Time frame: As noted, the Roche Systems test was recently approved by the FDA, while several others are in various stages of review and development.
Injectable Hydro Gel to Treat Spinal Disc Degeneration
Four out of 10 Americans suffer lower back pain, usually caused by intervertebral disc degeneration, which can lead to a herniated disc.
Typically, the treatment for advanced cases of herniated discs is a surgical discectomy, which leaves a void within the spinal disc. This void weakens the disc, leaving the patient vulnerable to more advanced degenerative disc disease.
Because of this, surgeons prescribe discectomies only when the patient has experienced a great deal of debilitating pain. The further degeneration of the disc leads to either a spinal fusion or an artificial disc replacement, expensive procedures requiring a lengthy hospital stay.
The promise of hydro gel technology is to either delay or stop disc damage, reducing the need for fusions and artificial disc replacement. This will allow discectomies to be performed earlier, more often, and as an outpatient procedure.
Hydrogels have been used for several years in various medical applications. They consist of natural or synthetic polymers and are made up mostly of water, but have the physical properties of a solid, like Jell-O.
These properties allow the gel to closely match the mechanical properties of soft tissues, making it an excellent scaffold material inside a spinal disc.
Time frame: 2018–2019
‘Viral’ Blood Filters
Blood infections can be caused by a wide range of pathogens, parasites, and toxins, and can often be fatal when a patient is already in a compromised state.
Blood infections can be not only deadly, they’re expensive. They affect more than 82,000 patients per year, costing an average $45,000 each to treat.
Blood filters have been used in dialysis, blood transfusions, and bypass systems for years. Scientists are now developing “viral” filter technology designed to remove infections, circulating tumor cells, and toxins from the bloodstream in order to allow drug therapies to be more effective.
Several designs are being studied. One promising technology, the Spleen-on-a-Chip (Wyss Institute for Biologically Inspired Engineering) is focused on using magnetic nano beads that target a wide variety of pathogens. The magnetic nano beads bind to pathogens in the patient’s blood. The blood is then passed through microchannels in an external filter system that removes the nano beads before the blood is returned to the patient.
The Aethlon Hemopurifier is another unique system currently in clinical trials in the U.S. Its first target is to remove pathogens such as HIV, hepatitis C, and other viruses from a patient’s bloodstream. The Hemopurifier is based on using cyanovirin, a plant-derived antibody that attracts the virus in the blood, allowing the larger cells to pass. The company is also developing membranes to target cancer cells. Early studies reflect that the technology decreased hepatitis C volume in dialysis patients by 57 percent.
Time frame: 2020–2025
Minimally invasive surgical and image guidance technologies have allowed for more procedures to be performed more quickly and with less trauma to the patient. One important limitation with minimally invasive surgery is the absence of true tactile feel, which is a key factor in assisting surgeons to distinguish tissue types and improve safety.
Bleeding due to a damaged blood vessel or organ can require a blood transfusion or shifting to a more invasive procedure. One study of 444 closed malpractice cases indicated that 12 percent were due to unexpected bleeding.
According to an FDA report, one challenge with the da Vinci is that surgeons must rely on vision and judgment, since they are not directly touching the surgical instruments.
The next generation of surgical robotics and instrumentation is focused on incorporating tactile feel and adding “intelligence” into the system. Tactile feel is a primary key to adding more safety to the procedure by allowing the surgeon more natural pressure feedback on critical structures.
Several technologies are being developed to provide tactile feedback. Basic versions use color display screens that give the surgeon a visual presentation of the force being applied. One design uses force-sensing technology on the working end of the instrumentation. The force on a device is then mimicked on a transducer that can be sensed by the surgeon. More advanced systems provide direct feedback to the joystick. The promise of tactile feel will assist surgeons in distinguishing tissue types along with improving outcomes.
Tactile technology promises to have a major impact on outcomes and cost reduction.
Time frame: 2018–2019
Telemedicine is not a single technology, but a collection of wireless systems working together to bridge the gap between the patient and the provider. It has constantly evolved to encompass more applications. It is estimated that Medicare payments for telemedicine services increased by 25 percent last year.
Telemedicine has allowed for remote monitoring of patient vital signs and images, and the sharing of patient records in both visual images and text formats.
Combined, these evolving technologies offer the promise of reducing cost while improving outcomes.
Historically, one major obstacle to the adoption of new technology is reimbursement. As the technology becomes more mainstream and is supported by hard data, this is changing. One development supporting the use of telemedicine is healthcare’s current shift from volume to value-based purchasing. This shift has changed the economic focus of patient care to saving over a longer term rather than on a per-procedure basis. This can be directly seen in helping to lower the rate of ER visits and re-hospitalizations.
One study showed $422 per patient savings in an ICU application, primarily through the reduction in the hospital stay and medications.
Time frame: It’s here, and getting better all the time.
James Laskaris is a senior emerging technology analyst with Dallas-based MD Buyline.