PMID- 9496875 OWN - NLM STAT- MEDLINE DCOM- 19980319 LR - 20041117 IS - 0038-4348 (Print) IS - 0038-4348 (Linking) VI - 91 IP - 2 DP - 1998 Feb TI - New approach to administrative medical decision-making: evidence-based medicine using high dose chemotherapy/bone marrow transplant for breast cancer. PG - 196-201 AB - BACKGROUND: Payment for experimental treatments using medical necessity criteria has been controversial. The process of obtaining a decision on coverage of an experimental treatment can be distressful for the treating physician, the patient, and family members. METHOD: The techniques of evidence-based medicine were used to assist with treatment/coverage decisions concerning high dose chemotherapy with autologous bone marrow transplants (HDC/ABMT) for invasive breast cancer. RESULTS: We reviewed the literature, finding minimal evidence for effectiveness of HDC/ABMT for invasive breast cancer; therefore, it is our opinion that it remains an experimental therapy. Its cost utility is likely to be low (approximately $100,000 per additional quality year gained). Numerous patients have been treated with HDC/ABMT outside of clinical trials, impeding scientific analysis of the treatment's effectiveness. CONCLUSION: Data-based policies and procedures for funding experimental medical treatments need to be developed to eventually replace the medical necessity criteria. FAU - Lucey, C AU - Lucey C AD - 21st Century Health Concepts, Baton Rouge, La 70809, USA. FAU - Westphal, J R AU - Westphal JR LA - eng PT - Journal Article PL - United States TA - South Med J JT - Southern medical journal JID - 0404522 RN - 0 (Antineoplastic Agents) SB - IM MH - Antineoplastic Agents/*administration & dosage/economics MH - *Bone Marrow Transplantation/economics MH - Breast Neoplasms/economics/*therapy MH - Combined Modality Therapy MH - Cost-Benefit Analysis MH - Evidence-Based Medicine MH - Female MH - Humans MH - Insurance Coverage MH - Insurance, Health, Reimbursement MH - Quality of Life MH - Quality-Adjusted Life Years MH - Transplantation, Autologous MH - Treatment Outcome EDAT- 1998/03/13 00:00 MHDA- 1998/03/13 00:01 CRDT- 1998/03/13 00:00 PHST- 1998/03/13 00:00 [pubmed] PHST- 1998/03/13 00:01 [medline] PHST- 1998/03/13 00:00 [entrez] PST - ppublish SO - South Med J. 1998 Feb;91(2):196-201.