COMMENTARY Essential Elements of a Technology and Outcomes Assessment Initiative

THEMISMATCHBETWEENUSHEALTHEXPENDITURES ANDthe resources devoted to learning which health in-terventions are most effective is both striking andunwise. Each year US individuals spend more than $2 trillion on health care.1 More than $100 billion is spent for research and development and for regulatory approval of new technologies. Yet total spending on technology as-sessment almost certainly falls short of $1 billion per year— 0.05 % of all US health care spending. Some of the $2 trillion in health care expenditures buys services of little or no value. This waste has been attributed to misleading advertisements, media hype, misguided state and federal mandates, fear of malpractice litigation, mis-aligned reimbursement incentives, and generous insur-ance that encourages patients to ignore the cost of ser-vices.2-4 Efforts to curb the inappropriate use of medical technologies, however, can have only limited success un-less they address the paucity of reliable information abou