Jim DupreeAssistant Professor, University of Michigan
- University of Michigan
- United States of America
About Jim Dupree
I applaud the authors for their expert review of this important topic. What investments do we need to make to get to the underlying cause of these findings? Are there key basic science or epidemiological infrastructures that should be built? As the authors conclude, there are key unanswered question that we must address to better understand what is happening to these men and how to improve their reproductive and overall health.
First, I would like to commend the editors and authors for their thorough summary of the pros and cons of using the robotic platform for reproductive medicine procedures.
Medicine is constantly evolving, with new medications, tests, and tools being added regularly to the marketplace. There is an inevitable balance and tension between early adoption and rigorous evaluation, since the best evaluations often take many years.
In today's US healthcare marketplace, there is also increasing attention on "value", often defined as quality divided by costs (multiplied by appropriateness). And I think the key question for the robotic platform is: "does it provide increased value over current approaches."
I applaud the early adopters for their work exploring the frontiers of the robotics platform and defining what's possible. Now, I think we need to turn our attention to a rigorous evaluation of the value of the platform. All 6 authors have highlighted the current knowledge base for cost and quality, but our current knowledge has many limitations, as described by the authors. Before we further expand this platform, I think we owe it to our patients, our field, and our healthcare system to evaluate rigorously the value it provides.
Drs, Foyouzi and Grody,
This is a very helpful review of the diverse genetic alterations found in men with CBAVD.
The cost difference between carrier screening and full gene sequencing seems significant. Is there a subset of patients in whom you think it would be highest value to use full gene sequencing as a first test? Also, what would the cost effectiveness be of doing carrier screening first in all patients and reserving full gene sequencing for only patients with negative carrier screens?
Jim Dupree, MD, MPH
Urology, University of Michigan