Alternative Research Funding to Improve Clinical Outcomes

Abstract

Although identification and management of cardiovascular risk markers have provided important population risk insights and public health benefits, individual risk prediction remains challenging. Using sudden cardiac death risk as a base case, the complex epidemiology of sudden cardiac death risk and the substantial new funding required to study individual risk are explored. Complex epidemiology derives from the multiple subgroups having different denominators and risk profiles, while funding limitations emerge from saturation of conventional sources of research funding without foreseeable opportunities for increases. A resolution to this problem would have to emerge from new sources of funding targeted to individual risk prediction. In this analysis, we explore the possibility of a research funding strategy that would offer business incentives to the insurance industries, while providing support for unresolved research goals. The model is developed for the case of sudden cardiac death risk, but the concept is applicable to other areas of the medical enterprise.

Sudden cardiac death in 2017: Spotlight on prediction and prevention

“…Ongoing discovery of novel SCD prediction methodology will need to be validated and tested prospectively in randomized clinical trials or pragmatic clinical trials, for which appropriate funding will need to be allocated and utilized. 16 …”

Sudden Cardiac Arrest Risk Assessment

“…It is beyond the scope of reality to expect that SCA/SCD will ever be close to being totally preventable nor will predictive models be absolute for targeting individuals at risk, but to the extent that we can improve individual prediction models, we will establish both clinical benefits for individual patients and economic benefits to the health care system. 38 It is not unreasonable to expect that data-driven changes in our guidelines for ICD use can be defined that might achieve 40% to 50% ICD use rates nor to expect that we could achieve better prediction of individual risk among the general low-risk population by more specific markers. None of this will occur without investments in the research enterprise targeted to improving effects and efficiencies.…”

“…Justification for this investment is based on population burden. As cited in a previous study 39 and developed in detail in a discussion of research funding, 38 the cumulative cost of the out-of-hospital cardiac arrest challenge in the United States is estimated at approximately $33 billion per year. At this level of cost, increasing investments for improving efficiencies is appropriate.…”

Health Care Costs After Cardiac Arrest in the United States

“…The latter supports the notion of increasing research support for prediction and prevention of cardiac arrest. 8,25 For example, in the years 2003 to 2004 and 2011 to 2012, the estimated annual inflation-adjusted cost postcardiac arrest in the United States was $7.3 and $11.1 billion, respectively. The ability of health outcomes research to reduce the incidence of cardiac arrest by 10% (2011-2012) would have saved the health care system ≈$1.2 billion.…”

“…Future studies are required to identify targeted interventions best associated with survival outcomes and lowest cost, in addition to supporting the potential economic value of funding research into prediction and prevention of cardiac arrest and sudden cardiac death. 25 …”