When I posted earlier, I had forgotten about the recent paper by Bryan Schmutz and Rex Santerre on the device tax and R&D. I still have not read it in full. Nevertheless, here’s the abstract:
Unlike the pharmaceutical industry, no empirical research has focused on the factors inﬂuencing research and development (R&D) spending in the medical device industry. To ﬁll that gap, this study examines how R&D spending is inﬂuenced by prior year cash ﬂow and corporate market value using multiple regression analysis and a panel data set of medical device companies over the period 1962–2008. The empirical ﬁndings suggest that the elasticities of R&D spending with respect to cash ﬂow and corporate market value equal 0.58 and 0.31, respectively. Moreover, based upon these estimates, simulations show that the recently enacted excise tax on medical devices, taken alone, will reduce R&D spending by approximately $4 billion and thereby lead to a minimum loss of $20 billion worth of human life years over the ﬁrst 10 years of its enactment.
I took a quick enough look to find out how the authors estimated the loss of life years. The key bits are these:
To translate that lost amount of medical device R&D spending in to the value of human lives lost, we use Neumann et al. (2000) median estimate of $40 000 cost per quality-adjusted life year (QALY) gained from medical devices to calculate a reasonable estimate of the amount of R&D spending needed to gain one QALY. In other words, prior research has determined that every $40 000 medical device sales gained one QALY. Using the 2007 median estimate for R&D intensity of approximately 0.06 (which is R&D divided by Sales) along with the 2007 adjusted median estimate of $51 444 cost per QALY (adjusting the $40 000 to year 2007 dollars), we calculate an estimate of $3087 of R&D spending needed to gain one QALY. […]
[W]e use a range of $200 000 to $300 000 to calculate the dollar value of life years lost to depressed medical device R&D spending.
By email, I asked Santerre if his work incorporates any effect on the industry of coverage expansion. His answer:
No we didn’t but the demand expansion effect may be slight for medical devices. Hospitals are the primary buyers rather than consumers and they have always strived to have the newest bells and whistles when it comes to medical devices. Also, they typically feel obligated to treat most patients when they come through the door even without insurance (legally they just have to stabilize the patient as Aaron reminds us). I don’t see much changing in that regard after the insurance mandate. However, if medical technology is the culprit behind the growth of health care spending and many (and I) believe, the tax on medical devices may be one way to slow down its growth. In other words, to slow the growth of health care spending, maybe people should die sooner than they would have otherwise.
I think we’d all prefer to slow the use of medical devices we know to be too broadly and harmfully applied. If we did so, instead of killing people, we might actually save a few.