FISCAL

Which medical interventions are worth it – Cost-effectiveness and sustainability of medical interventions?

Project timeline

Study design

Umbrella project

Status

Design

Why is this initiative needed?
Health care is a force for good, but it can be overused, underused and misused. Increasing evidence from around the world shows that overdiagnosis, overtreatment, and overuse of medical treatments all have the potential to harm, but this harm has currently been largely ignored.1 2

Abandoning ineffective medical practices and mitigating the risks of untested practices are crucial for improving patient health and containing healthcare costs3. It has been estimated that at least one third (1/3) of current medical expenditure in the US is ineffective or unnecessary.4  Equally importantly, important new research findings often go unnoticed and fail to elicit changes in clinical practice (Figure below).

What is the primary objective of the FISCAL Initiative?
The FISCAL Initiative aims to shift the emphasis of healthcare toward improved decision-making and principles of evidence-based medicine to counteract systemic biases favouring entrenched practices in the face of reliable scientific evidence.5

Where are we now?
So far, we have two primary FISCAL projects:

1) Placebo-surgery controlled trials; a series of trials assessing the efficacy of some of the most common orthopaedic procedures (read more).

2) FIASCO – Is the current – osteoporosis-based – strategy for prevention of fractures viable?; a series of critical, evidence-based analyses drilling into the current practices on how people with osteoporosis or at risk of sustaining an “osteoporotic” fracture are diagnosed and treated (read more).

  1. Brodersen J, Kramer BS, Macdonald H, Schwartz LM, Woloshin S. Focusing on overdiagnosis as a driver of too much medicine. BMJ. 2018 Aug 17;362:k3494. doi: 10.1136/bmj.k3494.
  2. Brownlee S, Chalkidou K, Doust J, et al. Evidence for overuse of medical services around the world. Lancet 2017;390(10090):156-68. doi: 10.1016/S0140-6736(16)32585-5
  3. Prasad V, Cifu A, Ioannidis JP. Reversals of established medical practices: evidence to abandon ship. JAMA 2012;307(1):37-8. doi: 10.1001/jama.2011.1960
  4. Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019 Oct 7. doi: 10.1001/jama.2019.13978.
  5. Prasad V, Ioannidis JP. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci 2014;9:1. doi: 10.1186/1748-5908-9-1

Principal investigators

No items found.

Publications

Clin Orthop Relat Res 2024 Oct 1

Kari Kanto, Clare L Ardern, Jonathan W Scott, Simo Taimela, Trevor Corson, Teppo L N Järvinen

Osteoarthritis Cartilage, 2019 Jul 23

Stefan Lohmander, Teppo Järvinen

BMJ Open, 2019 Jun 4

Kari Tikkinen, Jarno Rutanen, Allen Frances, Amna Maqbool, Brittany Dennis, Arnav Agarwal, Brea Perry, Shanil Ebrahim, Janne Leinonen, Teppo Järvinen, Gordon Guyatt

BMJ, 2019 Jan 23

Tero Kortekangas, Heidi Haapasalo, Tapio Flinkkilä, Pasi Ohtonen, Simo Nortunen, Heikki-Jussi Laine, Teppo Järvinen, Harri Pakarinen

Nature Reviews Rheumatology, 2017 Jul 6

Teppo Järvinen, Gordon Guyatt

Osteoarthritis and Cartilage, 2016 Aug, Epub 2016 Mar 31

Raine Sihvonen, Martin Englund, Aleksandra Turkiewicz, Teppo Järvinen

British Journal of Sports Medicine, 2015 Nov 16

Teppo Järvinen

BMJ, 2015 May 26

Teppo Järvinen, Karl Michaëlsson, Jarkko Jokihaara, Gary Collins, Thomas Perry, Barbara Mintzes, Vijaya Musini, Juan Erviti, Javier Gorricho, James Wright, Harri Sievänen

Journal of Internal Medicine, 2015 Mar 24

Teppo Järvinen, Karl Michaëlsson, Aspenberg P, Harri Sievänen

Canadian Medical Association Journal, 2014 May 20

Alan Cassels, Janne Leinonen, Teppo Järvinen

The New England Journal of Medicine, 2013 Dec 26

Raine Sihvonen, Mika Paavola, Antti Malmivaara, Ari Itälä, Antti Joukainen, Juha Kalske, Heikki Nurmi, Teppo Järvinen

Canadian Medical Association Journal, 2013 Dec 23

Teppo Järvinen, Jarkko Jokihaara, Pierre Guy, Pablo Alonso-Coello, Gary Collins, Karl Michaëlsson, Harri Sievänen

BMJ Open, 2012 Dec 2

Kari Tikkinen, Janne Leinonen, Gordon Guyatt, Shanil Ebrahim, Teppo Järvinen

BMJ, 2011 Apr 19

Teppo Järvinen, Harri Sievänen, Pekka Kannus, Jarkko Jokihaara, Karim Khan

Arthroscopy, 2010 May

Teppo Järvinen, Ghassan Alami, Jón Karlsson

BMC Musculoskeletal Disorders, 2010 Mar 11

Henrik Ahlborg, Björn Rosengren, Teppo Järvinen, Cecilia Rogmark, Jan-Åke Nilsson, Ingemar Sernbo, Magnus Karlsson

Musculoskeletal & Neuronal Interactions, 2008 Jan

Teppo Järvinen, Pekka Kannus, Harri Sievänen

BMJ, 2008 Jan 17

Teppo Järvinen, Harri Sievänen, Karim Khan, Ari Heinonen, Pekka Kannus

Best Pract Res Clin Rheumatol, 2007 Apr

Tero Järvinen, Teppo Järvinen, Minna Kääriäinen, Ville Aärimaa, Samuli Vaittinen, Hannu Kalimo, Markku Järvinen

PloS Medicine, 2007 Mar 6

Harri Sievänen, Pekka Kannus, Teppo Järvinen

The Lancet, 2005 Nov 26

Pekka Kannus, Harri Sievänen, Mika Palvanen, Teppo Järvinen, Jari Parkkari

Am J Sports Med, 2005 May

Tero Järvinen, Teppo Järvinen, Minna Kääriäinen, Hannu Kalimo, Markku Järvinen

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