Health care horizon scanning is an activity undertaken to identify technological and system innovations (pharmaceuticals, medical devices, diagnostic tests, procedures, therapeutic interventions, rehabilitative interventions, behavioral health interventions, public health, and health promotion activities) that could have important impacts or bring about paradigm shifts in the health care system. The Agency for Healthcare Research and Quality (AHRQ) established a national Healthcare Horizon Scanning System to identify interventions that purport to address important unmet needs and are up to 3 years out on the horizon and then to follow them up to 2 years after initial entry into the health care system. At any given time, between 500 and 650 topics meeting the criteria are being actively tracked in the system. About 15 to 20 percent of these interventions are developed enough (e.g., have late-phase data available) to consider for inclusion in a Potential High Impact Intervention report, which AHRQ publishes twice a year. In 2014, AHRQ requested exploratory, rapid, cost analyses to elucidate the potential 1-year spend of 53 selected interventions deemed to have potential for high impact on the health care system.
To estimate potential costs of these new and emerging interventions, medical librarians performed searches to identify data that analysts could use in the following categories: prevalence of the disease or condition targeted by each intervention; actual or projected 1-year adoption of the new intervention; costs of the intervention; costs of a similar intervention; and costs of an alternative intervention used for the disease or condition.
The high-end of the 1-year health care cost estimate for these 53 potential high-impact interventions was about $96.5 billion. This scenario assumed availability and implementation of all interventions in the estimated patient populations in a theoretical 1-year timeframe. The 53 interventions span 14 priority condition areas and 1 cross-cutting priority area. New drugs for treating one disease—direct-acting oral antivirals for interferon-free treatment of hepatitis C virus (HCV)—represented about $17 billion in 1-year health care expenditures if used to treat about 10 percent of the 3.2 million U.S. population estimated to have HCV infection. When considering categories of these interventions, such as drugs, devices, and procedures, new pharmaceuticals/biotechnologies and new off-label uses of existing pharmaceuticals constituted about 60 percent of estimated costs. Thirty-six interventions with an estimated annual spend of $500,000 to $1 billion each totaled about $11.4 billion. Eleven interventions with an estimated annual spend of more than $1 billion each totaled $35 billion in estimated spend (including the new oral drugs for treating hepatitis C).
Limitations of these rapid cost analyses include the short timeframe to produce them, limited available information requiring many assumptions, and a near-term view. Nonetheless, they do suggest that estimating short-term cost impacts is possible for novel health care interventions in development or just entering the market that purport to address unmet needs.