putting a value on the benefits of new medical technology. These two issues were addressed at the macro level and at the disease level for cardiovascular disease8 and metastatic melanoma.9 The conference agenda is in Appendix A.

In choosing these two diseases, the organizers of the conference sought to contrast the situation for a disease where there has been significant therapeutic progress, cardiovascular disease, with the situation for a disease with, to date, limited therapeutic progress, metastatic melanoma.10 Indeed, metastatic melanoma can be considered representative of many cancers in the sense that new drugs are becoming available that provide improvements but at substantial cost.

The second half of the conference addressed the impact of innovations in the pipeline and the barriers to these innovations. Barriers to innovation occur at all stages of the innovation cycle—development (potentially exciting ideas that do not leave the drawing board), adoption (coverage denied or delayed for cost-effective solutions), and diffusion (proven solutions only slowly replacing inferior approaches). Ways to overcome identified barriers to medical innovation were considered with respect to treatments for cardiovascular disease and for metastatic melanoma, as well as more generally.

Chapters 25 of this report summarize the discussion of the four principal themes of the conference:

  • The characteristics of medical innovation.

  • The costs and benefits of medical innovation.

  • Cost-effectiveness studies: a key to innovation development.

  • Barriers to medical innovation.

A list of conference participants is given in Appendix B. This list does not include those people who tuned into the conference webcast, which drew about 100 listeners each day.


Cardiovascular disease, principally heart disease and stroke, is the leading cause of death in the United States for both men and women among all racial and ethnic groups. More than 960,000 Americans die of cardiovascular disease each year, accounting for more than 40 percent of all deaths. In addition, about 58 million Americans live with some form of cardiovascular disease.


Melanoma is a malignant tumor that begins in the cells that produce skin coloring (melanocytes). When melanoma cells spread beyond the initial site to other parts of the body (for example, lymph nodes, liver, lungs) the disease is called metastatic melanoma. The incidence of melanoma in the United States is increasing. It is estimated that in 2001 about 51,000 new cases of melanoma will be diagnosed and about 7,800 deaths will be attributed to the disease.


It should be noted that other cancers (for example, cancers of the lung, bronchus, and pancreas) also have very low 5-year survival rates.

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