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Tirrell Z, Norman A, Hoyle M, Lybrand S, Parkinson B. Bring Out Your Dead: A Review of the Cost Minimisation Approach in Health Technology Assessment Submissions to the Australian Pharmaceutical Benefits Advisory Committee. PHARMACOECONOMICS 2024:10.1007/s40273-024-01420-9. [PMID: 39182009 DOI: 10.1007/s40273-024-01420-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES Published literature has levied criticism against the cost-minimisation analysis (CMA) approach to economic evaluation over the past two decades, with multiple papers declaring its 'death'. However, since introducing the requirements for economic evaluations as part of health technology (HTA) decision-making in 1992, the cost-minimisation analysis (CMA) approach has been widely used to inform recommendations about the public subsidy of medicines in Australia. This research aimed to highlight the breadth of use of CMA in Australia and assess the influence of preconditions for the approach on subsidy recommendations METHODS: Relevant information was extracted from Public Summary Documents of Pharmaceutical Benefits Advisory Committee (PBAC) meetings in Australia considering submissions for the subsidy of medicines that included a CMA and were assessed between July 2005 and December 2022. A generalised linear model was used to explore the relationship between whether medicines were recommended and variables that reflected the primary preconditions for using CMA set out in the published PBAC Methodology Guidelines. Other control variables were selected through the Bolasso Method. Subgroup analysis was undertaken which replicated this modelling process. RESULTS While the potential for inferior safety or efficacy reduced the likelihood of recommendation (p < 0.01), the effect sizes suggest that the requirements for CMA were not requisite for recommendation. CONCLUSION The Australian practice of CMA does not strictly align with the PBAC Methodology Guidelines and the theoretically appropriate application of CMA. However, within the confines of a deliberative HTA decision-making process that balances values and judgement with available evidence, this may be considered acceptable, particularly if stakeholders consider the current approach delivers sufficient clarity of process and enables patients to access medicines at an affordable cost.
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Affiliation(s)
- Zachary Tirrell
- Macquarie University, Macquarie University Centre for the Health Economy, Macquarie Park, NSW, Australia.
- Macquarie Business School, Macquarie University, Macquarie Park, Australia.
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, Australia.
| | - Alicia Norman
- Macquarie University, Macquarie University Centre for the Health Economy, Macquarie Park, NSW, Australia
- Macquarie Business School, Macquarie University, Macquarie Park, Australia
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Martin Hoyle
- Macquarie University, Macquarie University Centre for the Health Economy, Macquarie Park, NSW, Australia
- Macquarie Business School, Macquarie University, Macquarie Park, Australia
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, Australia
| | - Sean Lybrand
- Macquarie University, Macquarie University Centre for the Health Economy, Macquarie Park, NSW, Australia
| | - Bonny Parkinson
- Macquarie University, Macquarie University Centre for the Health Economy, Macquarie Park, NSW, Australia
- Macquarie Business School, Macquarie University, Macquarie Park, Australia
- Australian Institute for Health Innovation, Macquarie University, Macquarie Park, Australia
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Sharma D, Chauhan AS, Guinness L, Mehndiratta A, Dhiman A, Singh M, Prinja S. Understanding the extent of economic evidence usage for informing policy decisions in the context of India's national health insurance scheme: Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY). BMJ Glob Health 2024; 9:e015079. [PMID: 38857943 PMCID: PMC11168173 DOI: 10.1136/bmjgh-2024-015079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world's largest tax-funded insurance schemes. The present study was conducted to understand the decision-making process around the evolution (and revision) of health benefit packages (HBPs) and reimbursement rates within PM-JAY, with a specific focus on assessing the extent of use of economic evidence and role of various stakeholders in shaping these policy decisions. METHODS A mixed-methods study was adopted involving in-depth interviews with seven key stakeholders involved in HBP design and reimbursement rates decisions, and a survey of 80 government staff and other relevant stakeholders engaged in the implementation of PM-JAY. The data gathered were thematically analysed, and a coding framework was developed to explore specific themes. Additionally, publicly available documents were reviewed to ensure a comprehensive understanding of the decision-making processes. RESULTS Findings reveal a progressive transition towards evidence-based practices for policy decisions within PM-JAY. The initial version of HBP relied heavily on key criteria like disease burden, utilisation rates, and out-of-pocket expenditures, along with clinical opinion in shaping decisions around the inclusion of services in the HBP and setting reimbursement rates. Revised HBPs were informed based on evidence from a national-level costing study and broader stakeholder consultations. The use of health economic evidence increased with each additional revision with consideration of health technology assessment (HTA) evidence for some packages and reimbursement rates based on empirical cost evidence in the most recent update. The establishment of the Health Financing and Technology Assessment unit further signifies the use of evidence-based policymaking within PM-JAY. However, challenges persist, notably with regard to staff capacity and understanding of HTA principles, necessitating ongoing education and training initiatives. CONCLUSION While substantial progress has been made in transitioning towards evidence-based practices within PM-JAY, sustained efforts and political commitment are required for the ongoing systematisation of processes.
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Affiliation(s)
- Deepshikha Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akashdeep Singh Chauhan
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | | | | | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Tchouaket E, Kruglova K, Sieleunou I, Tsafack M, Tankwa JM, Takoguen G, Argiropoulos N, Robins S, Sia D. Knowledge, attitude, and practices of stakeholders involved in healthcare financing programs on economic evaluations in Cameroon. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003101. [PMID: 38662686 PMCID: PMC11045103 DOI: 10.1371/journal.pgph.0003101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
There are many healthcare financing programs (HFPs) in Cameroon; however, there is a lack of information on these programs' economic effectiveness and efficiency. Involvement of local stakeholders in the economic evaluations (EEs) of HFPs is critical for ensuring contextual factors are considered prior to program implementation. We conducted a cross-sectional study to assess the need for EEs of Cameroonian HFPs. Regular staff in supervisory roles aged 18 years and above were recruited in four Cameroonian cities. Data were collected via face-to-face surveys between June 15 and August 1, 2022. Descriptive analyses summarized participants' knowledge, attitudes, and practices in relation to performing EEs of HFPs. Principal component analyses identified organizational, individual, and contextual factors that could influence participants' involvement. The total sample included 106 participants. On average, 65% of participants reported being aware of the listed HFPs; however, of these, only 28% said that they had been involved in the HFPs. Of the 106 participants, 57.5% knew about EEs; yet, almost 90% reported that the HFP in question had never been subject to an EE, and 84% had never been involved in an EE. Most participants indicated that they had intended or would like to receive EE training. Using principal component analyses, the organizational factors were classified into two components ('policy and governance' and 'planning and implementation'), the individual factors were classified into two components ('training' and 'motivation'), and the contextual factors were classified into three components ('funding,' 'political economy,' and 'public expectations'). The findings of this study highlight the need to invest in EE training to improve participation rates of Cameroonian stakeholders in the EEs of HFPs. Improved knowledge, diversified skills, and increased participation of stakeholders from all levels of the Cameroonian healthcare system are critical to the effective and efficient development, implementation, and EE of the country's HFPs.
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Affiliation(s)
- Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | | | | | | | | | - Nikolas Argiropoulos
- Department of Mathematics and Statistics, Université de Montréal, Montréal, Québec, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
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4
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Hafez M, Nicolaou N, Offiah A, Obasohan P, Dixon S, Giles S, Madan S, Fernandes JA. How Much Does Paediatric Femoral Lengthening Cost? A Cost Comparison between Magnetic Lengthening Nails and External Fixators. Strategies Trauma Limb Reconstr 2023; 18:16-20. [PMID: 38033930 PMCID: PMC10682557 DOI: 10.5005/jp-journals-10080-1573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/23/2023] [Indexed: 12/02/2023] Open
Abstract
Aim Motorised intramedullary lengthening nails are considered more expensive than external fixators for limb lengthening. This research aims to compare the cost of femoral lengthening in children using the PRECICE magnetic lengthening nail with external fixation. Methods Retrospective analysis of 50 children who underwent femoral lengthening. One group included patients who were treated with PRECICE lengthening nails, the other group included patients who had lengthening with external fixation. Each group included 25 patients aged between 11 and 17 years. The patients in both groups were matched for age. Cost analysis was performed following micro-costing and analysis of the used resources during the different phases of the treatments. Results Each group's mean patient age was 14.7 years. Lengthening nails were associated with longer operative times compared with external fixators, both for implantation and removal surgery (p-values of 0.007 and < 0.0001, respectively). Length of stay following the implantation surgery, frequency of radiographs and frequency of outpatient department appointments were all lower with lengthening nails. The overall cost of lengthening nails was £1393 more than external fixators, however, this difference was not statistically significant (p-value = 0.088). Conclusion The difference in the mean costs between femoral lengthening with lengthening nails versus external fixators was not statistically significant. Further research to review the effectiveness of the devices and the quality of life during the lengthening process is crucial for robust health economic evaluation. How to cite this article Hafez M, Nicolaou N, Offiah A, et al. How Much Does Paediatric Femoral Lengthening Cost? A Cost Comparison between Magnetic Lengthening Nails and External Fixators. Strategies Trauma Limb Reconstr 2023;18(1):16-20.
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Affiliation(s)
- Mohamed Hafez
- Department of Paediatric Trauma and Orthopaedic, Sheffield Children's Hospital, Sheffield, England, United Kingdom
| | - Nicolas Nicolaou
- Department of Paediatric Trauma and Orthopaedic, Sheffield Children's Hospital, Sheffield, England, United Kingdom
| | - Amaka Offiah
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Phillips Obasohan
- Department of Medical Statistics, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Dixon
- Department of Health Economics and Decision Science, School of Health and Related Research, Sheffield, United Kingdom
| | - Stephen Giles
- Department of Trauma and Orthopaedics, Sheffield Children's Hospital, Sheffield, England, United Kingdom
| | - Sanjeev Madan
- Department of Paediatric Limb Reconstruction, Sheffield Children's Hospital NHS Trust, Sheffield, England, United Kingdom
| | - James Alfred Fernandes
- Department of Trauma and Orthopaedics, Sheffield Children's Hospital, Sheffield, England, United Kingdom
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Tchouaket EN, Kruglova K, Beogo I, Sia D, Robins S, Bélanger E, Jubinville M, Séguin C, Kilpatrick K, Boivin S, Létourneau J. Economic evaluation of healthcare-associated infection prevention and control in long-term care: a systematic review protocol. Syst Rev 2022; 11:261. [PMID: 36463274 PMCID: PMC9719189 DOI: 10.1186/s13643-022-02128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Given the high risk of contracting a healthcare-associated infection in long-term care facilities, infection prevention and control are essential for the quality of care and safety of residents and staff. To develop more effective infection prevention and control interventions in long-term care facilities, it is important to assess the cost-effectiveness and cost-benefit of existing interventions. There are only a few reviews on this subject, but these are not recent and most do not perform an economic evaluation. Moreover, none uses a discounting approach which limits inter-study comparison. To address these gaps, we will conduct a systematic review of economic evaluations related to healthcare-associated infection prevention and control in long-term care facilities using a discounting approach. METHODS We will query MEDLINE, Embase, Web of Science, Cochrane, CINAHL, EconLit, JSTOR, and Scopus, as well as the gray literature databases CORDIS and ProQuest. We will include quantitative studies that evaluate four clinical best practices associated with infection prevention and control (hand hygiene, hygiene and sanitation, screening, basic, and additional precautions) and use at least one of five economic analyses (cost-effectiveness, cost-benefit, cost-minimization, cost-utility, cost-consequences). Primary outcomes will include net cost savings, incremental cost-effectiveness ratio, incremental cost per quality-adjusted life year, and incremental cost per disability-adjusted life year. Two co-authors will independently screen and select articles, extract data, and assess the quality of selected articles using the Scottish Intercollegiate Guidelines Network criteria, the Economic Evaluation criteria, and the Cochrane criteria for economic evaluation. Extracted data will be synthesized, and values will be adjusted to 2022 Canadian dollars using the discount rates of 3%, 5%, and 8%. DISCUSSION Information obtained through this systematic review may help researchers and policy makers make more efficient use of limited healthcare resources to ensure the safety and quality of long-term care. SYSTEMATIC REVIEW REGISTRATION Research registry ID: reviewregistry1210.
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Affiliation(s)
- Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Catherine Séguin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montréal, Québec Canada
| | - Sandra Boivin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
| | - Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7 Canada
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6
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Martinus Hauge A, Otto EI, Wadmann S. The sociology of rationing: Towards increased interdisciplinary dialogue - A critical interpretive literature review. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1287-1304. [PMID: 35692110 PMCID: PMC9546068 DOI: 10.1111/1467-9566.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Since the 1990s, the sociology of rationing has developed in explicit opposition to health economic and bioethical approaches to healthcare rationing. This implies a limited engagement with other disciplines and a limited impact on political debates. To bring the sociology of rationing into an interdisciplinary dialogue, it is important to understand the disciplines' analytical differences and similarities. Based on a critical interpretive literature synthesis, this article examines four disciplinary perspectives on healthcare rationing and priority setting: (1) Health economics, which seeks to develop decision models to provide for more rational resource allocation; (2) Bioethics, which seeks to develop normative principles and procedures to facilitate a just allocation of resources; (3) Health policy studies, which focus on issues of legitimacy and implementation of decision models; and lastly (4) Sociology, which analyses the uncertainty of rationing and the resulting value conflicts and negotiations. The article provides an analytical overview and suggestions on how to advance the impact of sociological arguments in future rationing debates: Firstly, we discuss how to develop the concepts and assumptions of the sociology of rationing. Secondly, we identify specific themes relevant for sociological inquiry, including the recurring problem of how to translate administrative priority setting decisions into clinical practice.
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Affiliation(s)
| | - Eva Iris Otto
- Department of AnthropologyCopenhagen UniversityCopenhagenDenmark
| | - Sarah Wadmann
- VIVE – The Danish Center for Social Science ResearchCopenhagenDenmark
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Ha IH, Kim ES, Lee SH, Lee YJ, Song HJ, Kim Y, Kim KW, Cho JH, Lee JH, Shin BC, Lee J, Shin JS. Cost-Utility Analysis of Chuna Manual Therapy and Usual Care for Chronic Neck Pain: A Multicenter Pragmatic Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:896422. [PMID: 35646995 PMCID: PMC9131099 DOI: 10.3389/fmed.2022.896422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to compare the cost-effectiveness of manual therapy and usual care for patients with chronic neck pain. A cost-utility analysis alongside a pragmatic randomized controlled trial was conducted in five South Korean hospitals. Data were procured from surveys and nationally representative data. Participants were 108 patients aged between 19 and 60 years, with chronic neck pain persisting for at least 3 months and a pain intensity score of ≥5 on the numerical rating scale in the last 3 days. The study was conducted for 1 year, including 5 weeks of intervention and additional observational periods. Participants were divided into a manual therapy (Chuna) group and a usual care group, and quality-adjusted life-years, costs, and the incremental cost-effectiveness ratio were calculated. The quality-adjusted life-years of the manual therapy group were 0.024 higher than that of the usual care group. From the societal perspective, manual therapy incurred a lower cost—at $2,131—and was, therefore, the more cost-effective intervention. From a healthcare system perspective, the cost of manual therapy was higher, with an incremental cost-effectiveness ratio amount of $11,217. Manual therapy is more cost-effective for non-specific chronic neck pain management from both a healthcare system and societal perspective.
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Affiliation(s)
- In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Eun-San Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Hyun Jin Song
- College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Younhee Kim
- College of Medicine, Inha University, Incheon, South Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Jun-Hwan Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea.,Korean Medicine Life Science, Campus of Korea Institute of Oriental Medicine, University of Science and Technology, Daejeon, South Korea
| | - Byung-Cheul Shin
- School of Korean Medicine, Pusan National University, Yangsan, South Korea.,Spine & Joint Center, Pusan National University Korean Medicine Hospital, Ysangsan, South Korea
| | - Jinho Lee
- Jaseng Hospital of Korean Medicine, Seoul, South Korea
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Jorm C, Iedema R, Piper D, Goodwin N, Searles A. "Slow science" for 21st century healthcare: reinventing health service research that serves fast-paced, high-complexity care organisations. J Health Organ Manag 2021; ahead-of-print. [PMID: 33934583 PMCID: PMC8991071 DOI: 10.1108/jhom-06-2020-0218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick. Design/methodology/approach The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged. Findings Current approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the
in situ
dynamics and complexities that define health service delivery. Originality/value There is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.
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Affiliation(s)
- Christine Jorm
- NSW Regional Health Partners, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,School of Rural Medicine, University of New England, Armidale, Australia
| | - Rick Iedema
- Centre for Team Based Practice and Learning, King's College London School of Medical Education, London, UK
| | - Donella Piper
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,NSWRHP, Newcastle, Australia
| | - Nicholas Goodwin
- Research, Central Coast Local Health Network, Gosford, Australia.,Central Coast Research Institute, The University of Newcastle, Callaghan, Australia
| | - Andrew Searles
- Health Research Economics, The University of Newcastle Hunter Medical Research Institute, New Lambton, Australia
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Searles A, Piper D, Jorm C, Reeves P, Gleeson M, Karnon J, Goodwin N, Lawson K, Iedema R, Gray J. Embedding an economist in regional and rural health services to add value and reduce waste by improving local-level decision-making: protocol for the 'embedded Economist' program and evaluation. BMC Health Serv Res 2021; 21:201. [PMID: 33676496 PMCID: PMC7936595 DOI: 10.1186/s12913-021-06181-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Systematic approaches to the inclusion of economic evaluation in national healthcare decision-making are usual. It is less common for economic evaluation to be routinely undertaken at the ‘local-level’ (e.g. in a health service or hospital) despite the largest proportion of health care expenditure being determined at this service level and recognition by local health service decision makers of the need for capacity building in economic evaluation skills. This paper describes a novel program – the embedded Economist (eE) Program. The eE Program aims to increase local health service staff awareness of, and develop their capacity to access and apply, economic evaluation principles in decision making. The eE program evaluation is also described. The aim of the evaluation is to capture the contextual, procedural and relational aspects that assist and detract from the eE program aims; as well as the outcomes and impact from the specific eE projects. Methods The eE Program consists of a embedding a health economist in six health services and the provision of supported education in applied economic evaluation, provided via a community of practice and a university course. The embedded approach is grounded in co-production, embedded researchers and ‘slow science’. The sites, participants, and program design are described. The program evaluation includes qualitative data collection via surveys, semi-structured interviews, observations and field diaries. In order to share interim findings, data are collected and analysed prior, during and after implementation of the eE program, at each of the six health service sites. The surveys will be analysed by calculating frequencies and descriptive statistics. A thematic analysis will be conducted on interview, observation and filed diary data. The Framework to Assess the Impact from Translational health research (FAIT) is utilised to assess the overall impact of the eE Program. Discussion This program and evaluation will contribute to knowledge about how best to build capacity and skills in economic evaluation amongst decision-makers working in local-level health services. It will examine the extent to which participants are able to improve their ability to utilise evidence to inform decisions, avoid waste and improve the value of care delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06181-1.
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Affiliation(s)
- Andrew Searles
- Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia.
| | - Donella Piper
- New South Wales Regional Health Partners, Newcastle, Australia
| | - Christine Jorm
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,School of Rural Medicine, University of New England, Armidale, Australia
| | - Penny Reeves
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Maree Gleeson
- Faculty of Health and Medicine, School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Nicholas Goodwin
- Faculty of Health and Medicine, Central Coast Research Institute for Integrated Care, University of Newcastle & Central Coast Local Health District, Gosford, Australia
| | - Kenny Lawson
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Rick Iedema
- Centre for Team-Based Practice & Learning in Health Care, King's College London, London, UK
| | - Jane Gray
- Partnerships, Innovation and Research, Hunter New England Local Health District, New Lambton, Australia
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10
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Economic analysis of healthcare-associated infection prevention and control interventions in medical and surgical units: systematic review using a discounting approach. J Hosp Infect 2020; 106:134-154. [PMID: 32652215 PMCID: PMC7341040 DOI: 10.1016/j.jhin.2020.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
Nosocomial or healthcare-associated infections (HCAIs) are associated with a financial burden that affects both patients and healthcare institutions worldwide. The clinical best care practices (CBPs) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions aim to reduce this burden. The COVID-19 pandemic has confirmed these four CBPs are critically important prevention practices that limit the spread of HCAIs. This paper conducted a systematic review of economic evaluations related to these four CBPs using a discounting approach. We searched for articles published between 2000 and 2019. We included economic evaluations of infection prevention and control of Clostridioides difficile-associated diarrhoea, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Gram-negative bacilli. Results were analysed with cost-minimization, cost-effectiveness, cost-utility, cost-benefit and cost-consequence analyses. Articles were assessed for quality. A total of 11,898 articles were screened and seven were included. Most studies (4/7) were of overall moderate quality. All studies demonstrated cost effectiveness of CBPs. The average yearly net cost savings from the CBPs ranged from $252,847 (2019 Canadian dollars) to $1,691,823, depending on the rate of discount (3% and 8%). The average incremental benefit cost ratio of CBPs varied from 2.48 to 7.66. In order to make efficient use of resources and maximize health benefits, ongoing research in the economic evaluation of infection control should be carried out to support evidence-based healthcare policy decisions.
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11
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Tichenor M. Essential universal health coverage needs local capacity development. LANCET GLOBAL HEALTH 2020; 8:e748-e749. [PMID: 32446339 DOI: 10.1016/s2214-109x(20)30224-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Marlee Tichenor
- School of Social and Political Science, Chrystal Macmillan Building, The University of Edinburgh, Edinburgh EH8 9LD, UK.
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12
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Tchouaket EN, Beogo I, Sia D, Kilpatrick K, Séguin C, Baillot A, Nadar M, Parisien N, Boivin S. Protocol for a systematic review of economic analyses of nosocomial infection prevention and control interventions in OECD hospitals. BMJ Open 2020; 10:e037765. [PMID: 32665392 PMCID: PMC7365490 DOI: 10.1136/bmjopen-2020-037765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Nosocomial infections (NIs) are associated with extra treatment costs, medical complications, reduction of quality of life and mortality. This systematic review intends to consolidate the evidence on the economic evaluation of four clinical best practices (CBPs) related to NI prevention and control interventions: hand hygiene, hygiene and sanitation, admission screening and basic and additional precautions. It will measure the return on investment of these CBPs. METHODS AND ANALYSIS Electronic searches will be conducted on MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and JSTOR. OpenGrey will also be consulted for articles from 2000 to 2018, published in English or French. The population includes studies undertaken in medical or surgical units of hospitals of the Organisation for Economic Co-operation and Development countries. Studies will report the prevention and control of Clostridium difficile-associated diarrhoea, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and carbapenem-resistant Gram-negative bacilli. Interventions evaluating any of the four CBPs will be included. The design of articles will fall within randomised clinical trials, quasi-experimental, case-control, cohort, longitudinal and cross-sectional studies. Outcomes will include incremental cost-effectiveness ratio, incremental cost per quality-adjusted life-year, incremental cost per disability-adjusted life year and the incremental cost-benefit ratio, net costs and net cost savings. Two authors will independently screen studies, extract data and assess risk of bias using the Scottish Intercollegiate Guidelines, the Drummond Economic Evaluation criteria and the Cochrane criteria for Systematic Reviews of Interventions. Consolidated Health Economic Evaluation Reporting Standards will be used for data extraction. All values will be adjusted to Canadian dollars ($C) indexed to 2019 using the discount rates (3%, 5% and 8%) for sensitivity analyses. This review will demonstrate the effectiveness of the CBPs in prevention and control of NIs. Decision-makers will thus have evidence to facilitate sound decision-making according to the financial gains generated. ETHICS AND DISSEMINATION The results of this systematic review will be published in a peer-reviewed journal and presented at a relevant scientific conference. Ethical approval is not required because the data we will use do not include individual patient data.
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Affiliation(s)
| | - Idrissa Beogo
- School of Nursing and Health, Université de Saint-Boniface, Winnipeg, Manitoba, Canada
| | - Drissa Sia
- Nursing, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | | | | | - Aurelie Baillot
- Nursing, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Mahmoud Nadar
- Nursing, Université du Québec en Outaouais, Gatineau, Quebec, Canada
| | - Natasha Parisien
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
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13
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Garattini L, Padula A. HTA for pharmaceuticals in Europe: will the mountain deliver a mouse? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1-5. [PMID: 31440857 DOI: 10.1007/s10198-019-01103-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy.
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, 24020, Ranica, Italy
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Hoefman RJ, van Exel J, Brouwer WBF. The Monetary Value of Informal Care: Obtaining Pure Time Valuations Using a Discrete Choice Experiment. PHARMACOECONOMICS 2019; 37:531-540. [PMID: 30298280 DOI: 10.1007/s40273-018-0724-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Interventions in health care often not only have an effect on patients, but also on their informal caregivers. Caregiving can have a profound impact on the health and wellbeing of carers. Ignoring these spillovers in economic evaluations risks labelling interventions mistakenly as cost-effective, at the expense of informal caregivers. OBJECTIVE This paper investigates willingness-to-accept (WTA) values for an hour of informal care, corrected for positive and negative impacts of informal care, to facilitate the inclusion of informal care hours on the cost side of economic evaluations without double-counting spillover effects. METHODS A discrete choice experiment (DCE) was conducted among a representative sample of the adult population in the Netherlands (n = 552) in September 2011. An experimental design minimizing the D-error was used to construct choice sets with two unlabelled alternatives with the attributes 'hours caregiving', 'monetary compensation for caregiving' and seven impacts of caregiving. To operationalize the random utility model, we used a panel mixed multinomial logit (MMNL) parameter model. For calculation of WTA, we used both population-level parameters and individual-level parameters. RESULTS The mean WTA for an additional hour of informal care, corrected for positive and negative impacts of informal care, was €14.57. The signs of the coefficients were all in the expected directions. CONCLUSIONS This study reports a preference-based monetary value for informal care, corrected for other impacts. This valuation facilitates the inclusion of informal care hours on the cost side in economic evaluations without double-counting any spillover effects included on the effects side.
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Affiliation(s)
- Renske J Hoefman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Almutairi AR, Alkhatib NS, Oh M, Curiel-Lewandrowski C, Babiker HM, Cranmer LD, McBride A, Abraham I. Economic Evaluation of Talimogene Laherparepvec Plus Ipilimumab Combination Therapy vs Ipilimumab Monotherapy in Patients With Advanced Unresectable Melanoma. JAMA Dermatol 2019; 155:22-28. [PMID: 30477000 PMCID: PMC6439581 DOI: 10.1001/jamadermatol.2018.3958] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022]
Abstract
Importance A phase 2 trial comparing talimogene laherparepvec plus ipilimumab vs ipilimumab monotherapy in patients with advanced unresectable melanoma found no differential benefit in progression-free survival (PFS) but noted objective response rates (ORRs) of 38.8% (38 of 98 patients) vs 18.0% (18 of 100 patients), respectively. Objective To perform an economic evaluation of talimogene laherparepvec plus ipilimumab combination therapy vs ipilimumab monotherapy. Design, Setting, and Participants For PFS, cost-effectiveness and cost-utility analyses using a 2-state Markov model (PFS vs progression or death) was performed. For ORRs, cost-effectiveness analysis of the incremental cost of 1 additional patient achieving objective response was performed. In this setting based on a US payer perspective (2017 US dollars), participants were patients with advanced unresectable melanoma. Main Outcomes and Measures The PFS life-years and PFS quality-adjusted life-years were determined, and the associated incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were estimated. Also estimated was the ICER per 1 additional patient (out of 100 treated patients) achieving objective response. Base-case analyses were validated by sensitivity analyses. Results In PFS analyses, the cost of talimogene laherparepvec plus ipilimumab ($494 983) exceeded the cost of ipilimumab monotherapy ($132 950) by $362 033. The ICER was $2 129 606 per PFS life-years, and the ICUR was $2 262 706 per PFS quality-adjusted life-year gained. Probabilistic sensitivity analyses yielded an ICER of $1 481 208 per PFS life-year gained and an ICUR of $1 683 191 per PFS quality-adjusted life-year gained. In 1-way sensitivity analyses, the PFS hazard ratio and the utility of response were the most influential parameters. Talimogene laherparepvec plus ipilimumab has a 50% likelihood of being cost-effective at a willingness-to-pay threshold of $1 683 191 per PFS quality-adjusted life-year gained. In ORR analyses, talimogene laherparepvec plus ipilimumab ($474 904) vs ipilimumab alone ($132 810), a $342 094 difference, yielded an ICER of $1 629 019 per additional patient achieving objective response. In subgroup analyses by disease stage and BRAFV600E mutation status, ICERs ranged from $1 069 044 to $17 104 700 per 1 additional patient achieving objective response. Conclusions and Relevance The cost to gain 1 additional progression-free quality-adjusted life-year, 1 additional progression-free life-year, or to have 1 additional patient attain objective response is about $1.6 million. This amount may be beyond what payers typically are willing to pay. Combination therapy of talimogene laherparepvec plus ipilimumab does not offer an economically beneficial treatment option relative to ipilimumab monotherapy at the population level. This should not preclude treatment for individual patients for whom this regimen may be indicated.
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Affiliation(s)
- Abdulaali R. Almutairi
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, The University of Arizona, Tucson
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson
| | - Nimer S. Alkhatib
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, The University of Arizona, Tucson
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson
| | - Mok Oh
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, The University of Arizona, Tucson
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, Department of Medicine, College of Medicine, The University of Arizona, Tucson
- The University of Arizona Cancer Center, Tucson
| | - Hani M. Babiker
- The University of Arizona Cancer Center, Tucson
- Division of Hematology-Oncology, Department of Medicine, College of Medicine, The University of Arizona, Tucson
| | - Lee D. Cranmer
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Ali McBride
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson
- The University of Arizona Cancer Center, Tucson
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, The University of Arizona, Tucson
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson
- The University of Arizona Cancer Center, Tucson
- Department of Family and Community Medicine, College of Medicine, The University of Arizona, Tucson
- Matrix45, Tucson, Arizona
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Abstract
This paper aims to propose a methodological lens to the assessment of technological innovations in healthcare based on the principles of social, economic, and political sustainability. Starting from the consideration of a lack of a unified interpretative framework of health technology assessment, using a content analysis of the relevant literature on the topic, we identified both the scientific perspectives adopted by the scholars and the most widely discussed topics. Consequently, the less explored scientific areas were framed, and, therefore, those more susceptible to further investigation came to light. The result is an overall picture which highlights the absence of unified and generally accepted approaches to evaluation, together with the lack of awareness on the fact that the multiplicity of methods adopted is essentially connected to the multiplicity of innovations, for each of which a method (or a set of methods) of preferable evaluation can be prefigured. Based on these observations, we propose a general reference framework for evaluation, based on the Viable Systems Approach (vSa), and a schematic outline of the connections between the complexity of innovations and the evaluation methodologies.
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17
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Verbooy K, Hoefman R, van Exel J, Brouwer W. Time Is Money: Investigating the Value of Leisure Time and Unpaid Work. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1428-1436. [PMID: 30502787 DOI: 10.1016/j.jval.2018.04.1828] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/14/2018] [Accepted: 04/19/2018] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Lost unpaid work and leisure time of patients due to ill health often are not included in economic evaluations, even in those taking a societal perspective. This study investigated the monetary value of unpaid work and leisure time to enable the inclusion of patient time in economic evaluations. METHODS A contingent valuation study was performed to derive monetary values of unpaid work and leisure time. Data were collected with an online survey among a representative sample of people 18 years and older in the Netherlands in terms of age, sex, and educational level in January 2014 (n = 316). Willingness-to-accept (WTA) and willingness-to-pay (WTP) values were analyzed with a two-part model. First, a logistic regression model investigated the willingness to trade in the WTA/WTP tasks. Second, a log-transformed ordinary least squares regression model analyzed the level of positive WTA and WTP values. RESULTS The average WTA value for unpaid work was €15.83, and the average WTA value for leisure time was €15.86. The mean WTP value for leisure time was €9.37 when traded against unpaid work, and €9.56 when traded against paid work. Differences in monetary values of unpaid work and leisure time were partly explained by respondents' income, educational level, age, and household composition. CONCLUSIONS Researchers can adhere to the societal perspective by also including the value of hours of lost unpaid work and leisure time in economic evaluations. As a first indication of its value, we suggest applying the WTA value of €16.
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Affiliation(s)
- Kaya Verbooy
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Renske Hoefman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Bowers J, Cheyne H, Mould G, Miller M, Page M, Harris F, Bick D. A multicriteria resource allocation model for the redesign of services following birth. BMC Health Serv Res 2018; 18:656. [PMID: 30134882 PMCID: PMC6106921 DOI: 10.1186/s12913-018-3430-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many healthcare services are under considerable pressure to reduce costs while improving quality. This is particularly true in the United Kingdom's National Health Service where postnatal care is sometimes viewed as having a low priority. There is much debate about the service's redesign and the reallocation of resources, both along care pathways and between groups of mothers and babies with different needs. The aim of this study was to develop a decision support tool that would encourage a systemic approach to service redesign and that could assess the various quality and financial implications of service change options making the consequent trade-offs explicit. The paper describes the development process and an initial implementation as a preliminary exploration of the possible merits of this approach. METHODS Other studies have suggested that combining multicriteria decision analysis with programme budgeting and marginal analysis might offer a suitable basis for resource allocation decisions in healthcare systems. The Postnatal care Resource Allocation Model incorporated this approach in a decision support tool to analyse the consequences of varying design parameters, notably staff contacts and time, on the various quality domains and costs. The initial phase of the study focussed on mapping postnatal care, involving interviews and workshops with a variety of stakeholders. This was supplemented with a literature review and the resultant knowledge base was encoded in the decision support tool. The model was then tested with various stakeholders before being used in an NHS Trust in England. RESULTS The model provides practical support, helping staff explore options and articulate their proposals for the redesign of postnatal care. The integration of cost and quality domains facilitates trade-offs, allowing staff to explore the benefits of reallocating resources between hospital and community-based care, and different patient-categories. CONCLUSIONS The main benefits of the model include its structure for assembling the key data, sharing evidence amongst multi-professional teams and encouraging constructive, systemic debate. Although the model was developed in the context of the routine maternity services for mothers and babies in the days following birth it could be adapted for use in other health care services.
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Affiliation(s)
- John Bowers
- Stirling Management School, University of Stirling, Stirling, FK9 4LA UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Gillian Mould
- Stirling Management School, University of Stirling, Stirling, FK9 4LA UK
| | - Martin Miller
- Stirling Management School, University of Stirling, Stirling, FK9 4LA UK
| | - Miranda Page
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Debra Bick
- Florence Nightingale School of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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Onatade R, Appiah S, Stephens M, Garelick H. Evidence for the outcomes and impact of clinical pharmacy: context of UK hospital pharmacy practice. Eur J Hosp Pharm 2018; 25:e21-e28. [PMID: 31157062 DOI: 10.1136/ejhpharm-2017-001303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/13/2017] [Accepted: 08/15/2017] [Indexed: 01/09/2023] Open
Abstract
Objectives The role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to (1) highlight the need to identify and prioritise specific CP roles, responsibilities and practices that will bring the greatest benefit to patients and health systems and (2) describe systematic weaknesses in current research methodologies for evaluating CP services and propose a different approach. Method Published reviews of CP services are discussed using the Economic, Clinical and Humanistic Outcomes framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP. Results Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of CP often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding CP's definitive contribution to patient outcomes. Conclusion There is a need for more research work in National Health Service (NHS) hospitals, employing a different paradigm to address some of the weaknesses of existing research on CP practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital CP activities to patient care and the NHS.
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Affiliation(s)
- Raliat Onatade
- Pharmacy Department, Institute of Pharmaceutical Science, King's College London, London, UK.,Department of Natural Sciences, Faculty of Science and Technology, Middlesex University, London, UK
| | - Sandra Appiah
- Department of Natural Sciences, Faculty of Science and Technology, Middlesex University, London, UK
| | | | - Hemda Garelick
- Department of Natural Sciences, Faculty of Science and Technology, Middlesex University, London, UK
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Cheung K, Evers S, De Vries H, Levy P, Pokhrel S, Jones T, Danner M, Wentlandt J, Knufinke L, Mayer S, Hiligsmann M. Most important barriers and facilitators of HTA usage in decision-making in Europe. Expert Rev Pharmacoecon Outcomes Res 2018; 18:297-304. [DOI: 10.1080/14737167.2018.1421459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K.L. Cheung
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - S.M.A.A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - H. De Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - P. Levy
- Department of Economics, Paris Dauphine University, Paris, France
| | - S. Pokhrel
- Health Economics Research Group, Brunel University, London, UK
| | - T. Jones
- Health Economics Research Group, Brunel University, London, UK
| | - M. Danner
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - J. Wentlandt
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - L. Knufinke
- Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - S. Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - M. Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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21
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Feig C, Cheung KL, Hiligsmann M, Evers SMAA, Simon J, Mayer S. Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria. Expert Rev Pharmacoecon Outcomes Res 2017; 18:223-232. [DOI: 10.1080/14737167.2017.1375407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Chiara Feig
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Kei Long Cheung
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Mickaël Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Silvia M. A. A. Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Nicod E. Why do health technology assessment coverage recommendations for the same drugs differ across settings? Applying a mixed methods framework to systematically compare orphan drug decisions in four European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:715-730. [PMID: 27538758 PMCID: PMC5486466 DOI: 10.1007/s10198-016-0823-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/02/2016] [Indexed: 05/25/2023]
Abstract
PURPOSE Health technology assessment (HTA) coverage recommendations differ across countries for the same drugs. Unlike previous studies, this study adopts a mixed methods research design to investigate, in a systematic manner, these differences. METHODS HTA recommendations for ten orphan drugs appraised in England (NICE), Scotland (SMC), Sweden (TLV) and France (HAS) (N = 35) were compared using a validated methodological framework that breaks down these complex decision processes into stages facilitating their understanding, analysis and comparison, namely: (1) the clinical/cost-effectiveness evidence, (2) its interpretation (e.g. part of the deliberative process) and (3) influence on the final decision. This allowed qualitative and quantitative identification of the criteria driving recommendations and highlighted cross-country differences. RESULTS Six out of ten drugs received diverging HTA recommendations. Reasons for cross-country differences included heterogeneity in the evidence appraised, in the interpretation of the same evidence, and in the different ways of dealing with the same uncertainty. These may have been influenced by agency-specific evidentiary, risk and value preferences, or stakeholder input. "Other considerations" (e.g. severity, orphan status) and other decision modulators (e.g. patient access schemes, lower discount rates, restrictions, re-assessments) also rendered uncertainty and cost-effectiveness estimates more acceptable. The different HTA approaches (clinical versus cost-effectiveness) and ways identified of dealing with orphan drug particularities also had implications on the final decisions. CONCLUSIONS This research contributes to better understanding the drivers of these complex decisions and why countries make different decisions. It also contributed to identifying those factors beyond the standard clinical and cost-effectiveness tools used in HTA, and their role in shaping these decisions.
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Affiliation(s)
- Elena Nicod
- Department of Social Policy, LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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MOST IMPORTANT BARRIERS AND FACILITATORS REGARDING THE USE OF HEALTH TECHNOLOGY ASSESSMENT. Int J Technol Assess Health Care 2017; 33:183-191. [DOI: 10.1017/s0266462317000290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: Several studies have reported multiple barriers to and facilitators for the uptake of health technology assessment (HTA) information by policy makers. This study elicited, using best-worst scaling (BWS), the most important barriers and facilitators and their relative weight in the use of HTA by policy makers.Methods: Two BWS object case surveys (one for barriers, one for facilitators) were conducted among sixteen policy makers and thirty-three HTA experts in the Netherlands. A list of twenty-two barriers and nineteen facilitators was included. In each choice task, participants were asked to choose the most important and the least important barrier/facilitator from a set of five. We used Hierarchical Bayes modeling to generate the mean relative importance score (RIS) for each factor and a subgroup analysis was conducted to assess differences between policy makers and HTA experts.Results: The five most important barriers (RIS > 6.00) were “no explicit framework for decision-making process,” “insufficient support by stakeholders,” “lack of support,” “limited generalizability,” and “absence of appropriate incentives.” The six most important facilitators were: “availability of explicit framework for decision making,” “sufficient support by stakeholders,” “appropriate incentives,” “sufficient quality,” “sufficient awareness,” and “sufficient support within the organization.” Overall, perceptions did not differ markedly between policy makers and HTA experts.Conclusions: Our study suggests that barriers and facilitators related to “policy characteristics” and “organization and resources” were particularly important. It is important to stimulate a pulse at the national level to create an explicit framework for including HTA in the decision-making context.
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Wang J, Chmielowski B, Pellissier J, Xu R, Stevinson K, Liu FX. Cost-Effectiveness of Pembrolizumab Versus Ipilimumab in Ipilimumab-Naïve Patients with Advanced Melanoma in the United States. J Manag Care Spec Pharm 2017; 23:184-194. [PMID: 28125365 PMCID: PMC10398057 DOI: 10.18553/jmcp.2017.23.2.184] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent clinical trials have shown that pembrolizumab significantly prolonged progression-free survival and overall survival compared with ipilimumab in ipilimumab-naïve patients with unresectable or metastatic melanoma. However, there has been no published evidence on the cost-effectiveness of pembrolizumab for this indication. OBJECTIVE To assess the long-term cost-effectiveness of pembrolizumab versus ipilimumab in ipilimumab-naïve patients with unresectable or meta-static melanoma from a U.S. integrated health system perspective. METHODS A partitioned-survival model was developed, which divided overall survival time into progression-free survival and postprogression survival. The model used Kaplan-Meier estimates of progression-free survival and overall survival from a recent randomized phase 3 study (KEYNOTE-006) that compared pembrolizumab and ipilimumab. Extrapolation of progression-free survival and overall survival beyond the clinical trial was based on parametric functions and literature data. The base-case time horizon was 20 years, and costs and health outcomes were discounted at a rate of 3% per year. Clinical data-including progression-free survival and overall survival data spanning a median follow-up time of 15 months, as well as quality of life and adverse event data from the ongoing KEYNOTE-006 trial-and cost data from public sources were used to populate the model. Costs included those of drug acquisition, treatment administration, adverse event management, and disease management of advanced melanoma. The incremental cost-effectiveness ratio (ICER) expressed as cost difference per quality-adjusted life-year (QALY) gained was the main outcome, and a series of sensitivity analyses were performed to test the robustness of the results. RESULTS In the base case, pembrolizumab was projected to increase the life expectancy of U.S. patients with advanced melanoma by 1.14 years, corresponding to a gain of 0.79 discounted QALYs over ipilimumab. The model also projected an average increase of $63,680 in discounted perpatient costs of treatment with pembrolizumab versus ipilimumab. The corresponding ICER was $81,091 per QALY ($68,712 per life-year) over a 20-year time horizon. With $100,000 per QALY as the threshold, when input parameters were varied in deterministic one-way sensitivity analyses, the use of pembrolizumab was cost-effective relative to ipilimumab in most ranges. Further, in a comprehensive probabilistic sensitivity analysis, the ICER was cost-effective in 83% of the simulations. CONCLUSIONS Compared with ipilimumab, pembrolizumab had higher expected QALYs and was cost-effective for the treatment of patients with unresectable or metastatic melanoma from a U.S. integrated health system perspective. DISCLOSURES This study was supported by funding from Merck & Co., which reviewed and approved the manuscript before journal submission. Wang, Pellissier, Xu, Stevinson, and Liu are employees of, and own stock in, Merck & Co. Chmielowski has served as a paid consultant for Merck & Co. and received a consultant fee for clinical input in connection with this study. Chmielowski also reports receiving advisory board and speaker bureau fees from multiple major pharmaceutical companies. Wang led the modeling and writing of the manuscript. Chmielowski, Xu, Stevinson, and Pellissier contributed substantially to the modeling design and methodology. Liu led the data collection work and contributed substantially to writing the manuscript. In conducting the analysis and writing the manuscript, the authors followed Merck publication polices and the "cost-effectiveness analysis alongside clinical trials-good research practices and the CHEERS reporting format as recommended by the International Society for Pharmacoeconomics and Outcomes Research.
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Affiliation(s)
- Jingshu Wang
- 1 Predictive & Economic Modeling, Merck Research Laboratories
| | - Bartosz Chmielowski
- 4 Jonsson Comprehensive Cancer Center, Division of Hematology and Medical Oncology, University of California, Los Angeles
| | | | - Ruifeng Xu
- 1 Predictive & Economic Modeling, Merck Research Laboratories
| | - Kendall Stevinson
- 3 Outcomes Research, Merck Research Laboratories, Merck & Co., Lebanon, New Jersey
| | - Frank Xiaoqing Liu
- 2 Outcomes Research - Oncology, Center for Observational and Real World Evidence (CORE), Merck Research Laboratories, Merck & Co, North Wales, Pennsylvania
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Hoefman RJ, van Exel J, Brouwer WBF. Measuring Care-Related Quality of Life of Caregivers for Use in Economic Evaluations: CarerQol Tariffs for Australia, Germany, Sweden, UK, and US. PHARMACOECONOMICS 2017; 35:469-478. [PMID: 28039617 PMCID: PMC5357482 DOI: 10.1007/s40273-016-0477-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Informal care is often not included in economic evaluations in healthcare, while the impact of caregiving can be relevant for cost-effectiveness recommendations from a societal perspective. The impact of informal care can be measured and valued with the CarerQol instrument, which measures the impact of informal care on seven important burden dimensions (CarerQol-7D) and values this in terms of general quality of life (CarerQol-VAS). The CarerQol can be included at the effect side of multi-criteria analyses of patient interventions or in cost-effectiveness or utility analysis of interventions targeted at caregivers. OBJECTIVE At present, utility scores based on relative utility weights for the CarerQol-7D are only available for the Netherlands. This study calculates CarerQol-7D tariffs for Australia, Germany, Sweden, UK, and US. METHODS Data were collected among the general population in Australia, Germany, Sweden, UK, and US by an Internet survey. Utility weights were collected with a discrete choice experiment with two unlabeled alternatives described in terms of the seven CarerQol-7D dimensions. An efficient experimental design with priors obtained from the Netherlands was used to create the choice sets. Data was analyzed with a panel mixed multinomial logit model with random parameters. RESULTS In all five countries, the CarerQol-7D dimensions were significantly associated with the utility of informal care situations. Physical health problems were most strongly associated with the utility for informal care situations. The tariff was constructed by adding up the relative utility weights per category of all CarerQol-7D dimensions for each country separately. CONCLUSION The CarerQol tariffs for Australia, Germany, Sweden, UK, and US facilitate the inclusion of informal care in economic evaluations.
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Affiliation(s)
- Renske J Hoefman
- Netherlands Institute for Health Services Research, PO Box 1568, Utrecht, The Netherlands.
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Zegeye EA, Mbonigaba J, Kaye SB, Wilkinson T. Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:33-43. [PMID: 27637919 DOI: 10.1007/s40258-016-0280-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE. OBJECTIVE This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia. METHODS In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas. RESULTS A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting. CONCLUSION The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.
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Affiliation(s)
- Elias Asfaw Zegeye
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa.
| | - Josue Mbonigaba
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Sylvia Blanche Kaye
- School of Public Management and Economics, Durban University of Technology, Durban, South Africa
| | - Thomas Wilkinson
- PRICELESS SA, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Antoñanzas F, Terkola R, Postma M. The Value of Medicines: A Crucial but Vague Concept. PHARMACOECONOMICS 2016; 34:1227-1239. [PMID: 27444306 DOI: 10.1007/s40273-016-0434-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.
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Affiliation(s)
| | - Robert Terkola
- College of Pharmacy, University of Florida, Gainesville, FL, USA
- University of Groningen, Groningen, The Netherlands
| | - Maarten Postma
- Unit of Pharmacotherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Snoswell C, Smith AC, Scuffham PA, Whitty JA. Economic evaluation strategies in telehealth: Obtaining a more holistic valuation of telehealth interventions. J Telemed Telecare 2016; 23:792-796. [DOI: 10.1177/1357633x16671407] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Telehealth is an emerging area of medical research. Its translation from conception, to research and into practice requires tailored research and economic evaluation methods. Due to their nature telehealth interventions exhibit a number of extra-clinical benefits that are relevant when valuing their costs and outcomes. By incorporating methods to measure societal values such as patient preference and willingness-to-pay, a more holistic value can be placed on the extra-clinical outcomes associated with telehealth and evaluations can represent new interventions more effectively. Cost-benefit analysis is a method by which relevant costs and outcomes in telehealth can be succinctly valued and compared. When health economic methods are conducted using holistic approaches such as cost-benefit analysis they can facilitate the translation of telehealth research into policy and practice.
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Affiliation(s)
- Centaine Snoswell
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Paul A Scuffham
- School of Medicine & the Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- School of Medicine & the Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
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Toward Explicit Prioritization for the Caribbean: An EQ-5D Value Set for Trinidad and Tobago. Value Health Reg Issues 2016; 11:60-67. [PMID: 27986200 DOI: 10.1016/j.vhri.2016.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 05/16/2016] [Accepted: 07/29/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Resource allocation decision making in the Caribbean can be greatly enhanced by the introduction of cost per quality-adjusted life-year (QALY) analysis on the basis of local preferences. In the valuation literature there have been recommendations for the elicitation methods of the EuroQol five-dimensional questionnaire (EQ-5D) that combine discrete-choice experiment (DCE) for bulk valuation with a time trade-off component for rescaling. OBJECTIVES To create a three-level EQ-5D value set for Trinidad and Tobago using an elicitation method that takes into account the local constraints, and that can be easily deployed in other Caribbean islands. METHODS A D-efficient DCE was completed by a representative sample of 307 adults. A time trade-off procedure was used to obtain values for rescaling the DCE model on a scale anchored at 0 (dead) and 1 (full health). RESULTS A mixed logit analysis of the DCE data produced an internally valid model that is similar to the results obtained in earlier pilot studies. CONCLUSIONS This EQ-5D value set allows cost per QALY analyses to be carried out on the basis of preferences from Trinidad and Tobago, and the approach to the DCE design can be taken for similar value sets to be created in the small, resource-constrained health systems of the Caribbean. Some guidelines for the initial application and introduction of cost per QALY analysis into the Trinidad and Tobago health system are also presented.
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Schwarzer R, Rochau U, Saverno K, Jahn B, Bornschein B, Muehlberger N, Flatscher-Thoeni M, Schnell-Inderst P, Sroczynski G, Lackner M, Schall I, Hebborn A, Pugner K, Fehervary A, Brixner D, Siebert U. Systematic overview of cost-effectiveness thresholds in ten countries across four continents. J Comp Eff Res 2016; 4:485-504. [PMID: 26490020 DOI: 10.2217/cer.15.38] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To provide an overview of thresholds for incremental cost-effectiveness ratios (ICERs) representing willingness-to-pay (WTP) across multiple countries and insights into exemptions pertaining to the ICER (e.g., cancer). To compare ICER thresholds to individual country's estimated ability-to-pay. MATERIALS & METHODS We included AHRQ/USA, BIQG-GOEG/Austria, CADTH/Canada, DAHTA@DIMDI/Germany, DECIT-CGATS/Brazil, HAS/France, HITAP/Thailand, IQWiG/Germany, LBI-HTA/Austria, MSAC/Australia, NICE/England/Wales and SBU/Sweden. ICER thresholds were derived from systematic literature/website search/expert surveys. WTP was compared with ATP using Spearman's rank correlation. RESULTS Two general and explicitly acknowledged thresholds (England/Wales, Thailand), implicit thresholds in six countries and different ICER thresholds/decision-making rules in oncology were identified. Correlation between WTP and ability-to-pay was moderate. DISCUSSION Our overview supports country-specific discussions on WTP and on how to define value(s) within societies.
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Affiliation(s)
- Ruth Schwarzer
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria
| | - Ursula Rochau
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria
| | - Kim Saverno
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA
| | - Beate Jahn
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria
| | - Bernhard Bornschein
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria
| | - Nikolai Muehlberger
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria
| | - Magdalena Flatscher-Thoeni
- Program on Health Policy, Administration, Economics & Law, Department of Public Health & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria
| | - Petra Schnell-Inderst
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria
| | - Martina Lackner
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria
| | - Imke Schall
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria
| | - Ansgar Hebborn
- F Hoffmann-La Roche AG, Market Access Policy, Grenzacher Str. 124, 4070 Basel, Switzerland
| | - Karl Pugner
- Amgen, Department of Health Economics & Reimbursement, Dammstrasse 23, 6301 Zug, Switzerland
| | - Andras Fehervary
- Novartis International AG, Government Affairs Europe, Novartis Campus, Fabrikstrasse 1, 4002 Basel, Switzerland
| | - Diana Brixner
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.,Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA.,Program in Personalized Health Care, Outcomes Research Center, Department of Pharmacotherapy, University of Utah, 30 South 2000, Salt Lake City, UT 84112, USA
| | - Uwe Siebert
- Department of Public Health, Health Services Research & Health Technology Assessment, Institute of Public Health, Medical Decision Making & Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics & Technology, Eduard Wallnoefer Center I, 6060 Hall i.T., Austria.,Division of Public Health Decision Modelling, Health Technology Assessment & Health Economics, ONCOTYROL - Center for Personalized Cancer Medicine, Innrain 66a, 6020 Innsbruck, Austria.,Department of Health Policy & Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave., Boston, MA 02115, USA.,Institute for Technology Assessment & Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac Street, Boston, MA 02114-4724, USA
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Cost-effectiveness of phosphate binders among patients with chronic kidney disease not yet on dialysis: a long way to go. BMC Nephrol 2016; 17:75. [PMID: 27393192 PMCID: PMC4938934 DOI: 10.1186/s12882-016-0286-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/24/2016] [Indexed: 11/10/2022] Open
Abstract
Hyperphosphatemia management is integral to the management of patients with chronic kidney disease. This mineral abnormality is associated with greater costs, but so is its management, especially with the use novel phosphate binders. The economic evaluation of these pharmaceutical agents is increasingly needed to provide evidence for value of money spent and inform resource allocation. Recently, Nguyen et al. explored the economical attractiveness of Sevelamer relative to Calcium Carbonate among patients with chronic kidney disease not yet on dialysis and concluded that the former was cost-effective. The current commentary discusses the results of this analysis and sheds light on the methodological challenges of economic evaluations in this field.
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Roberts MH, Borrego ME, Kharat AA, Marshik PL, Mapel DW. Economic evaluations of fluticasone-propionate/salmeterol combination therapy for chronic obstructive pulmonary disease: a review of published studies. Expert Rev Pharmacoecon Outcomes Res 2016; 16:167-92. [PMID: 26839089 DOI: 10.1586/14737167.2016.1148602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review identifies and evaluates the comprehensive reporting of peer-reviewed economic evaluations of the effectiveness of fluticasone-propionate/salmeterol combination (FSC) therapy for maintenance treatment of chronic obstructive pulmonary disease (COPD). Economic evaluations were included if published in English since 2003. Evaluation categories included in the review were cost-effectiveness, cost-utility, and cost-consequence analyses. FSC is cost-effective in comparison to short-acting bronchodilators (SABDs). Cost and outcome differences between FSC and other long-acting therapies were modest. Studies exhibited large variations in populations, designs and environment, limiting the ability to draw conclusions. Many new maintenance treatments for COPD have been approved since 2010. Most have yet to be compared to older treatments like FSC. Evaluations are needed that consider costs and outcomes from a societal perspective (e.g., patients' ability to keep working) and evaluations that include subgroup analyses to investigate differential impacts according to clusters of patient characteristics.
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Affiliation(s)
- M H Roberts
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA.,b LCF Research, Health Services Research Division , Albuquerque , NM , USA
| | - M E Borrego
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - A A Kharat
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - P L Marshik
- a Department of Pharmacy Practice and Administrative Sciences , University of New Mexico College of Pharmacy , Albuquerque , NM , USA
| | - D W Mapel
- b LCF Research, Health Services Research Division , Albuquerque , NM , USA
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Rizk R, Hiligsmann M, Karavetian M, Evers SMAA. Economic evaluations of interventions to manage hyperphosphataemia in adult haemodialysis patients: A systematic review. Nephrology (Carlton) 2016; 21:178-87. [DOI: 10.1111/nep.12584] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Rana Rizk
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Mirey Karavetian
- Department of Natural Sciences in Public Health; College of Sustainability Sciences and Humanities; Zayed University; Dubai United Arab Emirates
| | - Silvia MAA Evers
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
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Brousselle A, Benmarhnia T, Benhadj L. What are the benefits and risks of using return on investment to defend public health programs? Prev Med Rep 2016; 3:135-8. [PMID: 27419005 PMCID: PMC4929139 DOI: 10.1016/j.pmedr.2015.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Return on investment (ROI) is an economic measure used to indicate how much economic benefit is derived from a program in relation to its costs. Interest in the use of ROI in public health has grown substantially over recent years. Given its potential influence on resource allocation, it is crucial to understand the benefits and the risks of using ROI to defend public health programs. In this paper, we explore those benefits and risks. We present two recent examples of ROI use in public health in the United States and Canada and conclude with a series of proposals to minimize the risks associated with using ROI to defend public health interventions. APHA and CPHA estimates of ROI on major public health range from 125% to 3900%. Assessing the economic value of public health programs using ROIs could provide robust arguments in their defense. Even if there are known benefits to using ROIs, there are also several risks. We offer recommendations for using ROI while acknowledging programs full range of impacts.
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Affiliation(s)
- Astrid Brousselle
- Canada Research Chair in Evaluation and Health System Improvement, Community Health Sciences Department, Centre de recherche de l'Hôpital Charles LeMoyne, Université de Sherbrooke, Canada
| | - Tarik Benmarhnia
- Institute for Health and Social Policy, McGill University, Canada
| | - Lynda Benhadj
- Centre de recherche de l'Hôpital Charles LeMoyne, Programme des sciences cliniques, Université de Sherbrooke, Canada
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Cheung KL, Evers SMAA, Hiligsmann M, Vokó Z, Pokhrel S, Jones T, Muñoz C, Wolfenstetter SB, Józwiak-Hagymásy J, de Vries H. Understanding the stakeholders' intention to use economic decision-support tools: A cross-sectional study with the tobacco return on investment tool. Health Policy 2016; 120:46-54. [PMID: 26718686 DOI: 10.1016/j.healthpol.2015.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/21/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite an increased number of economic evaluations of tobacco control interventions, the uptake by stakeholders continues to be limited. Understanding the underlying mechanism in adopting such economic decision-support tools by stakeholders is therefore important. By applying the I-Change Model, this study aims to identify which factors determine potential uptake of an economic decision-support tool, i.e., the Return on Investment tool. METHODS Stakeholders (decision-makers, purchasers of services/pharma products, professionals/service providers, evidence generators and advocates of health promotion) were interviewed in five countries, using an I-Change based questionnaire. MANOVA's were conducted to assess differences between intenders and non-intenders regarding beliefs. A multiple regression analysis was conducted to identify the main explanatory variables of intention to use an economic decision-support tool. FINDINGS Ninety-three stakeholders participated. Significant differences in beliefs were found between non-intenders and intenders: risk perception, attitude, social support, and self-efficacy towards using the tool. Regression showed that demographics, pre-motivational, and motivational factors explained 69% of the variation in intention. DISCUSSION This study is the first to provide a theoretical framework to understand differences in beliefs between stakeholders who do or do not intend to use economic decision-support tools, and empirically corroborating the framework. This contributes to our understanding of the facilitators and barriers to the uptake of these studies.
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Affiliation(s)
- Kei Long Cheung
- Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, GT Maastricht, 6229, The Netherlands.
| | - Silvia M A A Evers
- Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Duboisdomein 30, GT Maastricht, 6229, The Netherlands
| | - Mickaël Hiligsmann
- Caphri school of Public Health and Primary Care, Health Services Research, Maastricht University, Duboisdomein 30, GT Maastricht, 6229, The Netherlands
| | - Zoltán Vokó
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Pázmány Péter sétány 1/a, Budapest, 1117, Hungary; Syreon Research Institute, Thököly út 119, Budapest, 1146, Hungary
| | - Subhash Pokhrel
- Health Economics Research Group, Brunel University London, UB8 3PH, Uxbridge, United Kingdom
| | - Teresa Jones
- Health Economics Research Group, Brunel University London, UB8 3PH, Uxbridge, United Kingdom
| | - Celia Muñoz
- Centre for Research in Health and Economics (CRES), University Pompeu Fabra, Ramon Trias Fargas 25-27, Barcelona, 08005, Spain
| | - Silke B Wolfenstetter
- Institute of Health Economics and Health Care Management Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Member of the German Center for Lung Research (DZL), Ingolstädter Landstr. 1, Neuherberg, 85764, Germany
| | | | - Hein de Vries
- Caphri school of Public Health and Primary Care Health Promotion, Maastricht University, POB 616 6200, MD Maastricht, The Netherlands
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Adarkwah CC, van Gils PF, Hiligsmann M, Evers SM. Risk of bias in model-based economic evaluations: the ECOBIAS checklist. Expert Rev Pharmacoecon Outcomes Res 2015; 16:513-23. [DOI: 10.1586/14737167.2015.1103185] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Williams I, Bryan S. Lonely at the top and stuck in the middle? The ongoing challenge of using cost-effectiveness information in priority setting : Comment on "Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden". Int J Health Policy Manag 2015; 4:185-7. [PMID: 25774376 DOI: 10.15171/ijhpm.2015.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/11/2015] [Indexed: 11/09/2022] Open
Abstract
The topic of how cost-effectiveness information informs priority setting in healthcare remains important to both policy and practice. This commentary considers the study carried out by Eckard and colleagues in Sweden. In it we distinguish between the conditions at national and local levels and put forward some recommendations for research into local priority setting in particular.
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Affiliation(s)
- Iestyn Williams
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver General Hospital Research Pavilion, Vancouver, British Columbia, Canada
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Walton M. Applying complexity theory: a review to inform evaluation design. EVALUATION AND PROGRAM PLANNING 2014; 45:119-126. [PMID: 24780280 DOI: 10.1016/j.evalprogplan.2014.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 06/03/2023]
Abstract
Complexity theory has increasingly been discussed and applied within evaluation literature over the past decade. This article reviews the discussion and use of complexity theory within academic journal literature. The aim is to identify the issues to be considered when applying complexity theory to evaluation. Reviewing 46 articles, two groups of themes are identified. The first group considers implications of applying complexity theory concepts for defining evaluation purpose, scope and units of analysis. The second group of themes consider methodology and method. Results provide a starting point for a configuration of an evaluation approach consistent with complexity theory, whilst also identifying a number of design considerations to be resolved within evaluation planning.
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Affiliation(s)
- Mat Walton
- School of Health and Social Services, Massey University, New Zealand.
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Hoefman RJ, van Exel J, Brouwer W. How to include informal care in economic evaluations. PHARMACOECONOMICS 2013; 31:1105-19. [PMID: 24218135 DOI: 10.1007/s40273-013-0104-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Economic evaluations of health interventions aim to support decision making in healthcare. To effectively do so, evaluations need to include all relevant costs and effects of an intervention. Informal care provided by family or friends is an important element of care for many patients, but can have a profound impact on the health and well-being of carers. Therefore, informal care should be considered in economic evaluations of health interventions. Different methods to do so exist. This paper provides an overview of state-of-the-art methods available for this purpose, illustrated with practical examples. Since the choice of measurement and valuation technique depends on the type and perspective of the economic evaluation, this paper supports researchers in choosing the appropriate techniques to include informal care in their economic evaluation of a health intervention. We discuss the different approaches to measuring and valuing informal care, covering both partial and full valuation methods, allowing inclusion as costs or effects.
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Affiliation(s)
- Renske J Hoefman
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands,
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Methods of international health technology assessment agencies for economic evaluations--a comparative analysis. BMC Health Serv Res 2013; 13:371. [PMID: 24079858 PMCID: PMC3849629 DOI: 10.1186/1472-6963-13-371] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background The number of Health Technology Assessment (HTA) agencies increases. One component of HTAs are economic aspects. To incorporate economic aspects commonly economic evaluations are performed. A convergence of recommendations for methods of health economic evaluations between international HTA agencies would facilitate the adaption of results to different settings and avoid unnecessary expense. A first step in this direction is a detailed analysis of existing similarities and differences in recommendations to identify potential for harmonization. The objective is to provide an overview and comparison of the methodological recommendations of international HTA agencies for economic evaluations. Methods The webpages of 127 international HTA agencies were searched for guidelines containing recommendations on methods for the preparation of economic evaluations. Additionally, the HTA agencies were requested information on methods for economic evaluations. Recommendations of the included guidelines were extracted in standardized tables according to 13 methodological aspects. All process steps were performed independently by two reviewers. Results Finally 25 publications of 14 HTA agencies were included in the analysis. Methods for economic evaluations vary widely. The greatest accordance could be found for the type of analysis and comparator. Cost-utility-analyses or cost-effectiveness-analyses are recommended. The comparator should continuously be usual care. Again the greatest differences were shown in the recommendations on the measurement/sources of effects, discounting and in the analysis of sensitivity. The main difference regarding effects is the focus either on efficacy or effectiveness. Recommended discounting rates range from 1.5% - 5% for effects and 3% - 5% for costs whereby it is mostly recommended to use the same rate for costs and effects. With respect to the analysis of sensitivity the main difference is that oftentimes the probabilistic or deterministic approach is recommended exclusively. Methods for modeling are only described vaguely and mainly with the rational that the “appropriate model” depends on the decision problem. Considering all other aspects a comparison is challenging as recommendations vary regarding detailedness and addressed issues. Conclusion There is a considerable unexplainable variance in recommendations. Further effort is needed to harmonize methods for preparing economic evaluations.
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Dionne F, Mitton C, MacDonald T, Miller C, Brennan M. The challenge of obtaining information necessary for multi-criteria decision analysis implementation: the case of physiotherapy services in Canada. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:11. [PMID: 23688138 PMCID: PMC3699379 DOI: 10.1186/1478-7547-11-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/02/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As fiscal constraints dominate health policy discussions across Canada and globally, priority-setting exercises are becoming more common to guide the difficult choices that must be made. In this context, it becomes highly desirable to have accurate estimates of the value of specific health care interventions.Economic evaluation is a well-accepted method to estimate the value of health care interventions. However, economic evaluation has significant limitations, which have lead to an increase in the use of Multi-Criteria Decision Analysis (MCDA). One key concern with MCDA is the availability of the information necessary for implementation. In the Fall 2011, the Canadian Physiotherapy Association embarked on a project aimed at providing a valuation of physiotherapy services that is both evidence-based and relevant to resource allocation decisions. The framework selected for this project was MCDA. We report on how we addressed the challenge of obtaining some of the information necessary for MCDA implementation. METHODS MCDA criteria were selected and areas of physiotherapy practices were identified. The building up of the necessary information base was a three step process. First, there was a literature review for each practice area, on each criterion. The next step was to conduct interviews with experts in each of the practice areas to critique the results of the literature review and to fill in gaps where there was no or insufficient literature. Finally, the results of the individual interviews were validated by a national committee to ensure consistency across all practice areas and that a national level perspective is applied. RESULTS Despite a lack of research evidence on many of the considerations relevant to the estimation of the value of physiotherapy services (the criteria), sufficient information was obtained to facilitate MCDA implementation at the local level. CONCLUSIONS The results of this research project serve two purposes: 1) a method to obtain information necessary to implement MCDA is described, and 2) the results in terms of information on the benefits provided by each of the twelve areas of physiotherapy practice can be used by decision-makers as a starting point in the implementation of MCDA at the local level.
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Affiliation(s)
- Francois Dionne
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, School of Population and Public Health, University of British Columbia, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC V5Z 1M9, Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, School of Population and Public Health, University of British Columbia, 7th Floor, 828 West 10th Avenue, Research Pavilion, Vancouver, BC V5Z 1M9, Canada
| | | | - Carol Miller
- Canadian Physiotherapy Association, Ottawa, ON, Canada
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David MC, Bensink M, Higashi H, Donald M, Alati R, Ware RS. Monte Carlo simulation of the cost-effectiveness of sample size maintenance programs revealed the need to consider substitution sampling. J Clin Epidemiol 2012; 65:1200-11. [PMID: 23017637 DOI: 10.1016/j.jclinepi.2012.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 04/08/2012] [Accepted: 04/18/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of sample size maintenance programs in a prospective cohort. STUDY DESIGN AND SETTING The Living with Diabetes Study in Queensland, Australia is a longitudinal survey providing a comprehensive examination of health care utilization and disease progression among people with diabetes. Data from this study were used to compare the cost-effectiveness of a program incorporating substitution sampling with two alternative programs: "no follow-up" and "usual practice." RESULTS A program involving substitution sampling was shown to be the most effective with an additional 3,556 complete responses (compared with a "no follow-up" program) and an additional 2,099 complete responses (compared with "usual practice"). An incremental analysis through a Monte Carlo simulation found substitution sampling to be the most cost-effective option for maintaining sample size with an incremental cost-effective ratio of $54.87 (95% uncertainty interval $52.68-$57.25) compared with $87.58 ($77.89-$100.09) for "usual practice." CONCLUSIONS Based on the available data, a program involving substitution sampling is economically justified and should be considered in any approach with the aim of maintaining sample size. There is, however, a continuing need to evaluate the effectiveness of this option on other outcome measures, such as bias.
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Affiliation(s)
- Michael C David
- School of Population Health, The University of Queensland, Herston, Queensland 4006, Australia.
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Abstract
OBJECTIVE This review examines the impact of economic evaluation in informing national or local policies within both jurisdictions. We focus on the factors that have made the economic evaluation evolves differently in both settings. AREAS OF AGREEMENT Economic evaluation facilitates decision-making regarding the efficiency of interventions. The existence of national or local bodies regulating the process has contributed to increasing its use in decision-making and the development of its methods. AREAS OF CONTROVERSY Cost-effectiveness approach is based on the assumption of health maximization subject to a budget constraint. Decision-makers are not only interested in health maximization alone. This may result in policy-makers failing to consider economic evaluations into their allocation decisions. AREAS TO DEVELOP RESEARCH: Methods that incorporate wider decision-makers goals (mainly local) and research to study the real impact of economic evaluation in terms of improved efficiency and equity are particularly required.
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Callahan KP, Bridges JFP. Using comparative effectiveness research to inform decision-making: is there a role of economic evaluation? J Comp Eff Res 2012; 1:299-301. [DOI: 10.2217/cer.12.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kyle P Callahan
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA
| | - John FP Bridges
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA
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