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Vásquez P, Hall L, Merlo G. Societal Preferences in Health Technology Assessments for Rare Diseases and Orphan Drugs: A Systematic Literature Review of New Analytic Approaches. Value Health Reg Issues 2024; 44:101026. [PMID: 39059264 DOI: 10.1016/j.vhri.2024.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 05/24/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This systematic literature review aimed to explore experiences worldwide of societal preferences integration into health technology assessments (HTAs) for rare diseases (RDs) and orphan drugs (ODs) through the implementation of multicriteria decision analysis (MCDA), discrete choice experiments (DCEs), and person trade-off (PTO) methods, among others. METHODS A systematic search of the literature was conducted in April 2021 using PubMed, Cochrane, Embase, and Scopus databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used for the review phases. Finally, the Promoting Action on Research Implementation in Health Services framework was used to discuss the implementation of these instruments in the RD context. RESULTS A total of 33 articles met the inclusion criteria. The studies measured societal preferences for RD and OD as part of HTA using MCDA (n = 17), DCE (n = 8), and PTO (n = 4), among other methods (n = 4). These found that patients and clinicians do not prioritize funding based on rarity. The public is willing to allocate funds only if the OD demonstrates effectiveness and improves the quality of life, considering as relevant factors disease severity, unmet health needs, and quality of life. Conversely, HTA agency experts preferred their current approach, placing more weight on cost-effectiveness and evidence quality, even though they expressed concern about the fairness of the drug review process. CONCLUSIONS MCDA, PTO, and DCE are helpful and transparent methods for assessing societal preferences in HTA for RD and OD. However, their methodological limitations, such as arbitrary criteria selection, subjective scoring methods, framing effects, weighting adaptation, and value measurement models, could make implementation challenging.
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Affiliation(s)
- Paola Vásquez
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Gregory Merlo
- Healthcare Improvement Unit, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
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Yin Y, Peng Q, Ma L, Dong Y, Sun Y, Xu S, Ding N, Liu X, Zhao M, Tang Y, Mei Z, Shao H, Yan D, Tang W. QALY-type preference and willingness-to-pay among end-of-life patients with cancer treatments: a pilot study using discrete choice experiment. Qual Life Res 2024; 33:753-765. [PMID: 38079024 DOI: 10.1007/s11136-023-03562-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE Quality-adjusted life-year (QALY) is a dominant measurement of health gain in economic evaluations for pricing drugs. However, end-of-life (EoL) patients' preference for QALY gains in life expectancy (LE) and quality of life (QoL) during different disease stages remains unknown and is seldom involved in decision-making. This study aims to measure preferences and willingness-to-pay (WTP) towards different types of QALY gain among EoL cancer patients. METHODS We attributed QALY gain to four types, gain in LE and QoL, respectively, and during both progression-free survival (PFS) and post-progression survival (PPS). A discrete choice experiment including five attributes (the four QALY attributes and one cost attribute) with three levels each was developed and conducted with 85 Chinese advanced non-small cell lung cancer patients in 2022. All levels were set with QALY gain/cost synthesised from research on anti-lung cancer drugs recently listed by Chinese National Healthcare Security Administration. Each respondent answered six choice tasks in a face-to-face interview. The data were analysed using mixed logit models. RESULTS Patients valued LE-related QALY gain in PFS most, with a relative importance of 81.8% and a WTP of $43,160 [95% CI 26,751 ~ 59,569] per QALY gain. Respondents consistently preferred LE-related to QoL-related QALY gain regardless of disease stage. Patients with higher income or lower education levels tended to pay more for QoL-related QALY gain. CONCLUSION Our findings suggest a prioritised resource allocation to EoL-prolonging health technologies. Given the small sample size and large individual heterogeneity, a full-scale study is needed to provide more robust results.
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Affiliation(s)
- Yue Yin
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Qian Peng
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Longhao Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Yi Dong
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Yinan Sun
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
| | - Silu Xu
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Nianyang Ding
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Xiaolin Liu
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Mingye Zhao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Yaqian Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Zhiqing Mei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Hanqiao Shao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
| | - Dan Yan
- Department of Pharmacy, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.
| | - Wenxi Tang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China.
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Management, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, China.
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Clement F, Kirkham J. L’intérêt d’un modèle d’étude du rapport coût-efficacité des interventions pour traiter le trouble dépressif majeur au Canada. CMAJ 2024; 196:E144-E145. [PMID: 38316454 PMCID: PMC10843434 DOI: 10.1503/cmaj.231441-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Fiona Clement
- Département des sciences de la santé communautaire et Institut O'Brien de santé publique (Clement), Département de psychiatrie et Institut de recherche sur le cerveau Hotchkiss et Centre Mathison pour la recherche et l'éducation en santé mentale (Kirkham), École de médecine Cumming, Université de Calgary, Calgary, Alb.
| | - Julia Kirkham
- Département des sciences de la santé communautaire et Institut O'Brien de santé publique (Clement), Département de psychiatrie et Institut de recherche sur le cerveau Hotchkiss et Centre Mathison pour la recherche et l'éducation en santé mentale (Kirkham), École de médecine Cumming, Université de Calgary, Calgary, Alb
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Peasgood T, Howell M, Raghunandan R, Salisbury A, Sellars M, Chen G, Coast J, Craig JC, Devlin NJ, Howard K, Lancsar E, Petrou S, Ratcliffe J, Viney R, Wong G, Norman R, Donaldson C. Systematic Review of the Relative Social Value of Child and Adult Health. PHARMACOECONOMICS 2024; 42:177-198. [PMID: 37945778 PMCID: PMC10811160 DOI: 10.1007/s40273-023-01327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES We aimed to synthesise knowledge on the relative social value of child and adult health. METHODS Quantitative and qualitative studies that evaluated the willingness of the public to prioritise treatments for children over adults were included. A search to September 2023 was undertaken. Completeness of reporting was assessed using a checklist derived from Johnston et al. Findings were tabulated by study type (matching/person trade-off, discrete choice experiment, willingness to pay, opinion survey or qualitative). Evidence in favour of children was considered in total, by length or quality of life, methodology and respondent characteristics. RESULTS Eighty-eight studies were included; willingness to pay (n = 9), matching/person trade-off (n = 12), discrete choice experiments (n = 29), opinion surveys (n = 22) and qualitative (n = 16), with one study simultaneously included as an opinion survey. From 88 studies, 81 results could be ascertained. Across all studies irrespective of method or other characteristics, 42 findings supported prioritising children, while 12 provided evidence favouring adults in preference to children. The remainder supported equal prioritisation or found diverse or unclear views. Of those studies considering prioritisation within the under 18 years of age group, nine findings favoured older children over younger children (including for life saving interventions), six favoured younger children and five found diverse views. CONCLUSIONS The balance of evidence suggests the general public favours prioritising children over adults, but this view was not found across all studies. There are research gaps in understanding the public's views on the value of health gains to very young children and the motivation behind the public's views on the value of child relative to adult health gains. CLINICAL TRIAL REGISTRATION The review is registered at PROSPERO number: CRD42021244593. There were two amendments to the protocol: (1) some additional search terms were added to the search strategy prior to screening to ensure coverage and (2) a more formal quality assessment was added to the process at the data extraction stage. This assessment had not been identified at the protocol writing stage.
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Affiliation(s)
- Tessa Peasgood
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Howell
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia.
| | - Rakhee Raghunandan
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Amber Salisbury
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Marcus Sellars
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Joanna Coast
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Nancy J Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Emily Lancsar
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Rosalie Viney
- Centre for Health Economics, Research and Evaluation (CHERE), University of Technology Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Charles Perkins Centre D17, The University of Sydney, NSW, 2006, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Cam Donaldson
- Department of Health Services and Policy Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
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Clement F, Kirkham J. The value of a model to consider the cost-effectiveness of interventions for the treatment of major depressive disorder in Canada. CMAJ 2023; 195:E1518-E1519. [PMID: 37963615 DOI: 10.1503/cmaj.231441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Fiona Clement
- Department of Community Health Sciences and the O'Brien Institute for Public Health (Clement) and of Psychiatry, Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education (Kirkham), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Julia Kirkham
- Department of Community Health Sciences and the O'Brien Institute for Public Health (Clement) and of Psychiatry, Hotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education (Kirkham), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Cadham CJ, Prosser LA. Eliciting Trade-Offs Between Equity and Efficiency: A Methodological Scoping Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:943-952. [PMID: 36805575 DOI: 10.1016/j.jval.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation. METHODS We searched Ovid (Medline), EconLit, and Scopus prior to June 25, 2021. Inclusion criteria were: (1) peer-reviewed or (2) gray literature; (3) published in English; (4) survey-based; (5) parameterized a social welfare function to quantify inequality aversion or (6) elicited a trade-off in equity and efficiency characteristics of health interventions. Exclusion criteria were: (1) studies that did not conduct a trade-off or (2) theoretical studies. We abstracted details on study methods, results, and limitations. Studies were grouped by following approach: (1) social welfare function or (2) preference ranking and distributional weighting. We described findings separately for each approach category. RESULTS Seventy-seven papers were included, 28 parameterized social welfare functions and 49 were classified as preference ranking and distributional weighting. Study methods were heterogeneous. Studies were conducted across 29 countries. Sample sizes and composition, survey methods and question framing varied. Preferences for equity were mixed. Across both approach categories: 39 studies were classified as clear evidence of inequality aversion; 33 found mixed evidence; and 4 had no evidence of aversion. Evidence of between and within-study heterogeneity was found. Preferences for equity may differ by gender, profession, political ideology, income, and education. CONCLUSIONS Substantial variability in study methods limit the direct comparability of findings and their use in equity-informed cost-effectiveness analysis. Future researches using representative samples that explore within and between country heterogeneity is needed.
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Affiliation(s)
- Christopher J Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Lisa A Prosser
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA
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Hijazi W, Vandenberk B, Rennert-May E, Quinn A, Sumner G, Chew DS. Economic evaluation in cardiac electrophysiology: Determining the value of emerging technologies. Front Cardiovasc Med 2023; 10:1142429. [PMID: 37180811 PMCID: PMC10169721 DOI: 10.3389/fcvm.2023.1142429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Cardiac electrophysiology is a constantly evolving speciality that has benefited from technological innovation and refinements over the past several decades. Despite the potential of these technologies to reshape patient care, their upfront costs pose a challenge to health policymakers who are responsible for the assessment of the novel technology in the context of increasingly limited resources. In this context, it is critical for new therapies or technologies to demonstrate that the measured improvement in patients' outcomes for the cost of achieving that improvement is within conventional benchmarks for acceptable health care value. The field of Health Economics, specifically economic evaluation methods, facilitates this assessment of value in health care. In this review, we provide an overview of the basic principles of economic evaluation and provide historical applications within the field of cardiac electrophysiology. Specifically, the cost-effectiveness of catheter ablation for both atrial fibrillation (AF) and ventricular tachycardia, novel oral anticoagulants for stroke prevention in AF, left atrial appendage occlusion devices, implantable cardioverter defibrillators, and cardiac resynchronization therapy will be reviewed.
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Affiliation(s)
- Waseem Hijazi
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Elissa Rennert-May
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amity Quinn
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen Sumner
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Derek S. Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Rand LZ, Melendez‐Torres GJ, Kesselheim AS. Alternatives to the quality-adjusted life year: How well do they address common criticisms? Health Serv Res 2023; 58:433-444. [PMID: 36537647 PMCID: PMC10012222 DOI: 10.1111/1475-6773.14116] [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] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To analyze whether other outcome measures used in health technology assessment (HTA) address the criticisms of quality-adjusted life years (QALYs). DATA SOURCES AND STUDY SETTING HTA methods guidance from 11 US comparator countries (the G10 and Australia) and six value frameworks from US organizations were reviewed to identify health outcome measures currently used to evaluate the benefits of a drug. STUDY DESIGN The study involved a documentary analysis of guidelines to identify outcome measures used by the sampled HTA organizations. Similar outcomes were grouped together into outcome types. Each type was analyzed to determine the extent to which it replicates key advantages and responds to criticisms of QALYs extracted from the literature. EXTRACTION METHODS Outcomes were included if guidance from at least one HTA organization identified the outcome as acceptable for HTA. Outcomes measuring or evaluating the benefit, clinical effect, or impact of a drug or health technology was included; methods of calculating costs were excluded. PRINCIPAL FINDINGS Seven types of outcome measures were identified falling into three groups: preference-based, single-dimension outcomes, and outcomes using non-health perspectives. Among the seven QALY alternative outcome measures currently used for HTA by the sampled countries, no one outcome measure addresses all the QALY criticisms while retaining the advantageous features of the QALY. CONCLUSIONS Proposals to adopt health technology assessment (HTA) to support value-based pricing of prescription drugs in the US have faced pushback over the use of the QALY. There is no single "right" outcome measure, and the criticisms of QALYs apply to other outcome measures used to evaluate health. The measures identified have different features and strengths, which may be appropriate for specific decision making goals, but the QALY remains the best option for decision making that requires comparisons of the overall societal value of health gains.
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Affiliation(s)
- Leah Z. Rand
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Center for BioethicsHarvard Medical SchoolBostonMassachusettsUSA
| | - G. J. Melendez‐Torres
- Peninsula Technology Assessment Group (PenTAG), Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Aaron S. Kesselheim
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Center for BioethicsHarvard Medical SchoolBostonMassachusettsUSA
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Larsson S, Edlund C, Nauclér P, Svensson M, Ternhag A. Cost-Effectiveness Analysis of Temocillin Treatment in Patients with Febrile UTI Accounting for the Emergence of Antibiotic Resistance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:835-843. [PMID: 35989360 PMCID: PMC9596505 DOI: 10.1007/s40258-022-00748-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Antibiotic resistance has been listed as one of the biggest threats to global health today. A recent study has shown that treating febrile urinary tract infections with temocillin instead of cefotaxime leads to a reduced selection of antibiotic-resistant bacteria. However, a potential challenge with prioritizing temocillin over cefotaxime is the cost consequences. OBJECTIVE This study aimed to assess the cost effectiveness of using temocillin compared to cefotaxime in treating febrile urinary tract infections in a model that takes the emergence of antibiotic resistance into account. METHODS We used a Markov cohort model to estimate the costs and health effects of temocillin and cefotaxime treatment in febrile urinary tract infections in a Swedish setting. Health effects were assessed in terms of quality-adjusted life-years, and the primary outcome was the cost per quality-adjusted life-year gained with temocillin compared to cefotaxime. We used a 5-year time horizon. RESULTS The model results showed that temocillin treatment led to better health outcomes at a higher total cost. The cost per quality-adjusted life-year gained was approximately 38,400 EUR. Results from the sensitivity analysis suggested a 63% probability of temocillin being cost effective at a threshold of 50,000 EUR. Furthermore, results showed that the cost effectiveness of temocillin in febrile urinary tract infections is highly dependent on the drug cost. CONCLUSIONS As antibiotic consumption is a driving force of resistance, it is essential to consider the development of resistance when studying the health economic consequences of antibiotic treatments. In doing so, this study found temocillin to be cost effective for febrile urinary tract infections.
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Affiliation(s)
- Sofie Larsson
- Public Health Agency of Sweden, Solna, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | | | - Pontus Nauclér
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anders Ternhag
- Public Health Agency of Sweden, Solna, Sweden
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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Sewankambo NK, Kutyabami P. Empowering local research ethics review of antibacterial mass administration research. Infect Dis Poverty 2022; 11:103. [PMID: 36171611 PMCID: PMC9516823 DOI: 10.1186/s40249-022-01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Recent studies using mass drug administration (MDA) of antibiotics to entire communities have focused global attention on the unique ethical challenges of MDA of antibiotics in research and public health interventions. However, there is no specific guidance for Research Ethics Committees (RECs) or Institutional Review Boards (IRBs) to review such trials. We surveyed the literature to identify the unique ethical challenges and to strengthen the competencies of RECs or IRBs in low- and middle-income countries (LMICs) in their ethical reviews of these trials. METHODS We employed a desk review. We searched PubMed, Web of Science, and Google Scholar, combining terms for "mass drug administration" with terms for "research ethics committees," "institutional review boards," and "ethics." We reviewed citations of search results to retrieve additional articles. Only articles published and indexed in the above databases up to 6 January 2022 in English were included. Abstracts (without full articles), books and articles that had exclusive veterinary and environmental focus were excluded. We synthesized the literature to identify particularly challenging ethical issues relevant to antibacterial MDA trials in LMICs. RESULTS The most challenging ethical issues can be categorised into four broad domains: determining the social value of MDA, assessing risks and benefits, engaging all stakeholders meaningfully, and study design-related ethical challenges. These four domains interact and impact each other. Together, they reveal the need for RECs/IRBs to review MDA studies through a broader lens than that of clinical trials per se. From our findings, we propose a framework to guide the RECs and IRBs in LMICs to perform the initial and continuing review of antibiotic MDA trials. We also recommend strengthening the competencies of LMIC RECs or IRBs through ongoing training and collaboration with RECs or IRBs from high-income countries. CONCLUSIONS REC/IRB review of research using MDA of antibiotics plays a critical role in assuring the ethical conduct of MDA studies. Local RECs/IRBs should be empowered to review MDA studies comprehensively and competently in order to advance scientific knowledge about MDA and promote improved global health.
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Affiliation(s)
- Nelson K Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Paul Kutyabami
- Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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Chew D, Clement F. Open Access Budget Impact Assessment Tools: A Welcome Step in Supporting Evidence-Informed Policy Decisions. Can J Cardiol 2022; 38:1485-1487. [DOI: 10.1016/j.cjca.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
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Attema AE, Brouwer WBF, Pinto JL. The Role of Perceived Utility of Full Health in Age Weighting. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1559-1565. [PMID: 35680548 DOI: 10.1016/j.jval.2022.04.1733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES People often give different weights to quality-adjusted life-years (QALYs) gained by different socioeconomic groups. It is well known that QALY gains of younger patients generally get more weight than the same QALY gains accruing to older patients. This study aims to separate these age-related preferences into "pure age weighting" and age weighting caused by full health not perceived as being the same for the old as for the young. METHODS We apply a person trade-off method in a large sample representative (N = 500) of the Dutch general adult population to estimate age weighting factors. We describe health as a percentage of what is considered full health for a given age, for which we obtain a proxy in a separate task. RESULTS A high amount of age weighting is observed, with QALYs to 20-year-old patients receiving approximately 1.5 times as much weight as QALYs to 80-year-old patients. At the same time, we see that individuals do not perceive full health to be the same for young and older people. In fact, the age weighting disappears once we control for these differences in full health perceptions. CONCLUSIONS Respondents had strong preferences for the young relative to the old, but these preferences were related to full health perceptions, that is, more weight being assigned to younger because full health is at a higher absolute level for them than for the old.
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Affiliation(s)
- Arthur E Attema
- EsCHER, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- EsCHER, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jose Luis Pinto
- Department of Economics, Universidad de Navarra, Pamplona, Spain
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Kovács S, Németh B, Erdősi D, Brodszky V, Boncz I, Kaló Z, Zemplényi A. Should Hungary Pay More for a QALY Gain than Higher-Income Western European Countries? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:291-303. [PMID: 35041177 PMCID: PMC9021143 DOI: 10.1007/s40258-021-00710-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Cost-effectiveness thresholds (CETs) play a particularly important role in the reimbursement decisions of health technologies in countries with limited healthcare resources. Our goal is to develop a scientifically solid proposal for a revised cost-effectiveness threshold, as part of the planned review of the Hungarian health economic guidance. METHODS The Threshold Working Group of the Hungarian Health Economics Association performed a targeted review on CETs in European countries. International trends on CETs served as a basis for our recommendation, which was discussed at the Association's workshop and deliberated at an expert committee meeting with representatives from the national health technology assessment (HTA) and healthcare payer bodies, and academic HTA centres. RESULTS The current Hungarian CET is one of the highest among European countries relative to GDP per capita, and even higher in nominal value than the CET applied by NICE. As opposed to the current, single Hungarian threshold, other European countries apply multiple thresholds. The Working Group recommends that Hungary should also apply multiple CETs in the range of 1.5-3 times GDP per capita with stratification according to the relative quality-adjusted life-year (QALY) gain of the new technology. In addition, multiple CETs in the range of 3-10 times GDP per capita is recommended for technologies in rare diseases. CONCLUSIONS CETs should be aligned with the country's economic performance and should reflect societal preferences. Our recommendation may increase the efficiency of healthcare resource allocation in Hungary by strengthening the role of HTA in the reimbursement decisions and favouring new technologies with higher QALY gain.
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Affiliation(s)
- Sándor Kovács
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pecs, Hungary
- Syreon Research Institute, Budapest, Hungary
| | | | - Dalma Erdősi
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pecs, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Imre Boncz
- Institute for Health Insurance, Faculty of Health Sciences, University of Pécs, Pecs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Antal Zemplényi
- Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pecs, Hungary.
- Syreon Research Institute, Budapest, Hungary.
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Kouakou CRC, Poder TG. Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:277-299. [PMID: 34417905 DOI: 10.1007/s10198-021-01364-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 05/12/2023]
Abstract
The use of a threshold for cost-utility studies is of major importance to health authorities for making the best allocation decisions for limited resources. Regarding the increasing number of studies worldwide that seek to establish a value for a quality-adjusted life year (QALY), it is necessary to review these studies to provide a global insight into the literature. A systematic review on willingness to pay (WTP) studies focusing on QALY was conducted in eight databases up to June 26, 2020. From a total of 9991 entries, 39 studies were selected, and 511 observations were extracted for the meta-analysis using the ordinary least squares method. The results showed a predicted mean empirical value of $52,619.39 (95% CI 49,952.59; 55,286.19) per QALY in US dollars for 2018. A 1% increase in income led to an increase of 0.6% in the WTP value, while a 1-year increase in respondent age led to a decrease of 3.3% in the WTP value. Sex, education level and employment status had significant effects on WTP. Compared to face-to-face interviews, surveys conducted by the internet or telephone were more likely to have a significantly higher value of WTP per QALY, while out-of-pocket payment tended to lower the value. The prediction made for the province of Quebec, Canada, provided a QALY value of approximately USD $98,450 (CAD $127,985), which is about 2.3 times its gross domestic product (GDP) per capita in 2018. This study is consistent with the extant literature and will be useful for countries that do not yet have a preference-based survey for the value of a QALY.
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Affiliation(s)
- Christian R C Kouakou
- Department of Economics, School of Business, University of Sherbrooke, Sherbrooke, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'Île de Montréal, Montreal, Canada
| | - Thomas G Poder
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'Île de Montréal, Montreal, Canada.
- Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, Canada.
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15
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Magalhaes M. Should rare diseases get special treatment? JOURNAL OF MEDICAL ETHICS 2022; 48:86-92. [PMID: 34815319 DOI: 10.1136/medethics-2021-107691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Orphan drug policy often gives 'special treatment' to rare diseases, by giving additional priority or making exceptions to specific drugs, based on the rarity of the conditions they aim to treat. This essay argues that the goal of orphan drug policy should be to make prevalence irrelevant to funding decisions. It aims to demonstrate that it is severity, not prevalence, which drives our judgments that important claims are being overlooked when treatments for severe rare diseases are not funded. It shows that prioritising severity avoids problems caused by prioritising rarity, and that it is compatible with a range of normative frameworks. The implications of a severity-based view for drug development are then derived. The severity-based view also accounts for what is wrong with how the current system of drug development unfairly neglects common diseases that burden the developing world. Lastly, the implications of a severity-based view for current orphan drug policies are discussed.
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Affiliation(s)
- Monica Magalhaes
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, USA
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Schurer M, Matthijsse SM, Vossen CY, van Keep M, Horscroft J, Chapman AM, Akehurst RL. Varying Willingness to Pay Based on Severity of Illness: Impact on Health Technology Assessment Outcomes of Inpatient and Outpatient Drug Therapies in The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:91-103. [PMID: 35031104 DOI: 10.1016/j.jval.2021.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Since 2015, Zorginstituut Nederland (ZIN) has linked disease severity ranges of 0.10 to 0.40, 0.41 to 0.70, and 0.71 to 1.00 with willingness-to-pay (WTP) reference values of €20 000, €50 000, and €80 000 per quality-adjusted life year gained, respectively. We sought to review whether these changes have affected ZIN health technology assessment (HTA) outcomes for specialist and outpatient drugs. METHODS ZIN recommendations for specialist and outpatient drugs published between January 1, 2012, and December 31, 2020, that included a pharmacoeconomic report were reviewed. Data were extracted on disease severity, proportional shortfall calculation, reported WTP reference value, outcomes related to the cost-effectiveness of the product, budget impact, and ZIN's recommendation including rationale for their advice. RESULTS A total of 51 HTAs were included. Of the 20 HTAs published before June 2015, a total of 9 received positive recommendations, 7 were conditionally reimbursed, and 4 received negative recommendations. None reported WTP reference values. Of the 31 evaluations published after June 2015, a total of 4 products received positive recommendations, 1 was conditionally approved, and 26 received negative recommendations initially. Most products (65%) reported disease severity to be >0.70. CONCLUSIONS Since 2015, most products have fallen within the highest category of disease severity. Although pre-2015 outcomes were varied, post-2015 products overwhelmingly received negative recommendations, and the proportion of products for which price negotiations were recommended has increased. These differences in outcomes may result from the introduction of an explicit WTP reference value, whether or not in combination with the severity-adjusted ranges, but may also reflect other national policy changes in 2015.
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Basu S. Approaches to critical care resource allocation and triage during the COVID-19 pandemic: an examination from a developing world perspective. J Med Ethics Hist Med 2021; 14:5. [PMID: 34849214 PMCID: PMC8595072 DOI: 10.18502/jmehm.v14i5.5652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/13/2021] [Indexed: 12/16/2022] Open
Affiliation(s)
- Saurav Basu
- Senior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
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18
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The application of the QALY measure in the assessment of the effects of health interventions on an older population: a systematic scoping review. Arch Public Health 2021; 79:201. [PMID: 34794496 PMCID: PMC8600812 DOI: 10.1186/s13690-021-00729-7] [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: 07/22/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background One of the most commonly used types of evaluation methods is cost-utility analysis (CUA), using the Quality Adjusted Life Year (QALY) indicator as a preference-based measure for assessing effects of a given programme. Such assessments are often translated into health-care provision priorities; therefore, effectively choosing the method of outcome evaluation is crucial for ensuring the best possible allocation of scarce resources. The main objective of this scoping review is to identify what kinds of problems and limitations may occur when the QALY indicator is used to assess the effects of health interventions in the older population. Methods To identify literature in a scoping review, the databases MEDLINE via PubMed and Scopus were searched. A manual search on relevant organizations’ and associations’ websites was also conducted (EUnetHTA, ISPOR and national governmental agencies responsible for allocation decisions). No limits concerning publication dates were set. All relevant data were extracted and analyzed, then a narrative summary was prepared. Results The database search identified 10,832 relevant items, finally 32 studies were included in the analysis. The main types of issues indicated in the studies were as follows: (1) lower life expectancy in the older population causes lower QALY gains; (2) an equal value of one QALY is used regardless of age; (3) poorer average health state causes lower QALY gains; (4) inadequate instruments to measure quality of life (QoL); (5) attributes of QoL used regardless of age; and (6) no beyond-health QoL aspects taken into account. Conclusions This review shows clearly that many problems of different types are connected with using QALY for the older population, but there is no consensus as to whether QALY discriminates against the older population or not – an opinion regarding this issue depends strongly on accepted principles, particularly the approach to equity and how one understands fairness. Health care resources should not be allocated solely on the basis of the health maximization rule because this can lead to discrimination against certain groups (e.g., older, disabled, and/or chronically ill people). To maintain the balance between efficiency and equity, the issues connected with age-based rationing should be widely discussed.
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Peel JK, Keshavjee S, Krahn M, Sander B. Economic evaluations and costing studies of lung transplantation: A scoping review. J Heart Lung Transplant 2021; 40:1625-1640. [PMID: 34538540 DOI: 10.1016/j.healun.2021.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/31/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Evaluation of the joint clinical and economic impacts of lung transplant and associated technologies is crucial for evidence-informed decision-making and wise allocation of scarce healthcare resources. We performed a scoping review to summarize and categorize the available evidence of the costs and cost-effectiveness of lung transplantation. METHODS A systematic search of MEDLINE, EMBASE, NHS EED, and EconLit was performed to identify studies involving lung transplantation for adults that measured costs, cost-effectiveness, or which described themselves as economic evaluations. A scoping review was performed in adherence to the framework described by Arksey & O'Malley. Risk of bias was assessed in included studies using the ECOBIAS and CHEC-list tools. RESULTS In total, 324 studies were identified, of which 28 met inclusion criteria. Cost-utility estimates of lung transplant versus waitlist, from the healthcare payer perspective and a time-horizon of at least 10-years ranged between $42,459 and $154,051 per quality-adjusted life year. Common topics of study included lung transplant versus waitlist care, immunosuppression, organ retrieval and allocation, and mechanical life support. CONCLUSIONS Sources of variation in costs-assessments and economic evaluations included differences in the type of study performed, payer perspective adopted, study time horizon, and variation in clinical practice. The best available cost-utility estimates for lung transplant versus waitlist may represent cost-effectiveness under some circumstances, but high-quality evidence is lacking. Further cost-utility analyses, with sufficient methodologic rigour, are required to overcome the observed variation in results and confirm cost-effectiveness of the current standard of care in lung transplantation.
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Affiliation(s)
- J K Peel
- Department of Anesthesiology & Pain Medicine, University of Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.
| | - S Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - M Krahn
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
| | - B Sander
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
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Rand LZ, Kesselheim AS. Controversy Over Using Quality-Adjusted Life-Years In Cost-Effectiveness Analyses: A Systematic Literature Review. Health Aff (Millwood) 2021; 40:1402-1410. [PMID: 34495724 DOI: 10.1377/hlthaff.2021.00343] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Researchers and policy makers in the US are exploring the implementation of health technology assessment and value-based pricing to negotiate drug prices and limit spending. Objections made to the quality-adjusted life-year (QALY), the most frequently used health economic outcome for such assessments, are a barrier to the adoption of these tools. This literature review identifies and addresses the range of criticisms made against QALYs. Methods-based criticisms require attention from stakeholders to address well-known shortcomings of the QALY and ensure consistency. Ethical criticisms, however, do not apply only to the QALY and require political decisions about societal values. Understanding and overcoming criticisms of the QALY to enable its use as part of health technology assessment and value-based pricing will be crucial as US policy makers seek to address high drug costs and health care spending.
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Affiliation(s)
- Leah Z Rand
- Leah Z. Rand is a postdoctoral fellow in the Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, in Boston, Massachusetts
| | - Aaron S Kesselheim
- Aaron S. Kesselheim is a professor of medicine at Harvard Medical School, in Boston, Massachusetts, and the director of the Program on Regulation, Therapeutics, and Law, Brigham and Women's Hospital
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21
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Afsharmanesh G, Rahimi F, Zarei L, Peiravian F, Mehralian G. Public and decision-maker stated preferences for pharmaceutical subsidy decisions in Iran: an application of the discrete choice experiment. J Pharm Policy Pract 2021; 14:74. [PMID: 34488901 PMCID: PMC8422609 DOI: 10.1186/s40545-021-00365-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background The argument about funding criteria poses challenges for health decision-makers in all countries. This study aimed to investigate the public and decision-maker preferences for pharmaceutical subsidy decisions in Iran. Methods A discrete choice experiment (DCE) was used for eliciting the preferences of the public and decision-makers. Four attributes including health gain after treatment, the severity of the disease, prevalence of the disease, and monthly out of pocket and relevant levels were designed in the form of hypothetical scenarios. The analysis was done by using conditional logit analysis. Results The results show all of four attributes are important for pharmaceutical subsidy decisions. But a medicine that improves health gain after treatment is more likely to be a choice in subsidy decisions (by relative importance of 28% for public and 42% for decision-makers). Out of pocket, severity, and prevalence of disease subsequently influence the preferences of the public and decision-makers, respectively. The greatest difference is observed in changing the health gain after treatment and out of pocket levels, between public and decision-makers. Conclusion This research reveals that the public is willing and able to provide preferences to inform policymakers for pharmaceutical decision-making; it also sets grounds for further studies. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-021-00365-0.
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Affiliation(s)
- Gita Afsharmanesh
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Vali-e-asr, Niayesh Junction, Tehran, Iran
| | - Farimah Rahimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Zarei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzad Peiravian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Vali-e-asr, Niayesh Junction, Tehran, Iran
| | - Gholamhossein Mehralian
- Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Vali-e-asr, Niayesh Junction, Tehran, Iran.
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22
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Reckers-Droog V, van Exel J, Brouwer W. Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1182-1192. [PMID: 34372984 DOI: 10.1016/j.jval.2021.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVES Decision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of disease severity and do not account for age-related preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study examines the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and age of patients, and the outcome of the disease. METHODS We obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of patients' disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and respondent characteristics on the WTP. RESULTS Respondents' WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains. CONCLUSIONS Our results suggest that-if the aim is to align resource-allocation decisions in healthcare with societal preferences-currently applied equity weights do not suffice.
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Affiliation(s)
- Vivian Reckers-Droog
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands
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Delpasand M, Olyaaeemanesh A, Jaafaripooyan E, Abdollahiasl A, Davari M, Kazemi Karyani A. Eliciting the public preferences for pharmaceutical subsidy in Iran: a discrete choice experiment study. J Pharm Policy Pract 2021; 14:59. [PMID: 34256875 PMCID: PMC8278681 DOI: 10.1186/s40545-021-00345-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Deciding on pharmaceutical subsidy is regarded as a challenging issue for healthcare policymakers in Iran in most times. Public preferences, rarely attended in Iran, could be invaluable for including a particular drug in the list of subsidized medications. OBJECTIVES The current study aims to elicit the public preferences to develop an evidence-based decision-making framework for entering a drug into the list of subsidies in Iran. METHODS Discrete Choice Experiment (DCE) was employed to elicit the public preferences. Around 34 attributes were identified based on the systematic review and interview with 51 experts. By holding an expert panel, 7 attributes were finalized, namely: the survival after treatment, quality of life after treatment (QoL), alternative treatment, age group of the target population, cost burden for the government, disease severity, and drug manufacturer country. Next, 1224 households were selected for the survey in the city of Tehran, using random cluster sampling. Data were analyzed using conditional logit model. RESULTS The survival after treatment (β = 1.245; SE = 0.053) and disease severity (β =- 0.143; SE = 0.043) had the highest and lowest priority, respectively, in the preferences for allocating subsidy to a drug. In developed region, unlike the other two regions, the level of domestic drug production (β =- 0.302; SE = 0.073) was inversely associated with preferences toward allocating subsidy to a drug. In contrast to other districts, those living in district number one (β = 2.053; SE = 0.138) gave the highest value to promoting the QoL after treatment. CONCLUSIONS It is suggested that policymakers pay more attention to attributes such as effectiveness and alternative treatment when developing an evidence-based framework for entering a drug into the list of subsidies. This study highlighted the public belief in the government's subsidy for medicines, provided that, this results in an increased survival and QoL.
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Affiliation(s)
- Mansoor Delpasand
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaaeemanesh
- Health Equity Research Center & National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Abdollahiasl
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Davari
- Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Comparing Public and Provider Preferences for Setting Healthcare Priorities: Evidence from Kuwait. HEALTHCARE (BASEL, SWITZERLAND) 2021; 9:healthcare9050552. [PMID: 34066745 PMCID: PMC8151973 DOI: 10.3390/healthcare9050552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/22/2022]
Abstract
As attempts are made to allocate health resources more efficiently, understanding the acceptability of these changes is essential. This study aims to compare the priorities of the public with those of health service providers in Kuwait. It also aims to compare the perceptions of both groups regarding key health policies in the country. Members of the general public and a sample of health service providers, including physicians, dentists, nurses, and technicians, were randomly selected to complete a structured, self-administered questionnaire. They were asked to rank health services by their perceived importance, rank preferred sources of additional health funding, and share their perceptions of the current allocation of health resources, including current healthcare spending choices and the adequacy of total resources allocated to healthcare. They were also asked for their perception of the current local policies on sending patients abroad for certain types of treatments and the policy of providing private health insurance for retirees. The response rate was above 75% for both groups. A higher tax on cigarettes was preferred by 73% of service providers as a source of additional funding for healthcare services, while 59% of the general public group chose the same option. When asked about the sufficiency of public sector health funding, 26.5% of the general public thought that resources were sufficient to meet all healthcare needs, compared with 40% of service providers. The belief that the public should be offered more opportunities to influence health resource allocation was held by 56% of the general public and 75% of service providers. More than half of the respondents from both groups believed that the policy on sending patients abroad was expensive, misused, and politically driven. Almost 64% of the general public stated that the provision of private health insurance for retirees was a ‘good’ policy, while only 34% of service providers agreed with this statement. This study showed similarities and differences between the general public and health service providers’ preferences. Both groups showed a preference for treating the young rather than the old. The general public preferred more expensive health services that had immediate effects rather than health promotion activities with delayed benefits and health services for the elderly. These findings suggest that the general public may not accept common allocative efficiency improvements in public health spending unless the challenges in this sector and the gains from reallocation are clearly communicated.
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Makin C, Neumann P, Peschin S, Goldman D. Modelling the value of innovative treatments for Alzheimer's disease in the United States. J Med Econ 2021; 24:764-769. [PMID: 33989095 DOI: 10.1080/13696998.2021.1927747] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alzheimer's disease (AD) is the predominant cause of dementia and a leading cause of death globally. With no cure or treatment to slow disease progression, AD-related healthcare costs are substantial and increase as the severity of the disease progresses. Given the complexity of this disease, including initial pathophysiological damage occurring decades before clinical manifestation, finding new impactful treatments for AD relies on highly innovative research and development. However, such sizable and sustained investments bring into question whether conventional value assessment models are fit for this purpose. In this article, we examine the importance and challenges of assimilating the perspectives of varied stakeholders, including patients, caregivers, health systems, payers, and society at large, into a comprehensive value assessment model that may be well suited for a breakthrough treatment for AD.
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Affiliation(s)
- Charles Makin
- Medical Health Outcomes Research, Biogen, Cambridge, MA, USA
| | - Peter Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Sue Peschin
- Alliance for Aging Research, Washington, DC, USA
| | - Dana Goldman
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
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Carlson JJ, Brouwer ED, Kim E, Wright P, McQueen RB. Alternative Approaches to Quality-Adjusted Life-Year Estimation Within Standard Cost-Effectiveness Models: Literature Review, Feasibility Assessment, and Impact Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1523-1533. [PMID: 33248507 DOI: 10.1016/j.jval.2020.08.2092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVES The quality-adjusted life-year (QALY) has been long debated, but alternative estimation approaches have not been comprehensively evaluated. Our objective was to identify alternatives, characterize them by implementation feasibility, and evaluate the impact of implementing feasible options in cost-effectiveness models developed for the Institute for Clinical and Economic Review reports. METHODS We conducted a literature review combining keywords relating to QALYs, methodology alternatives, and cost-effectiveness in PubMed, EconLit, Web of Science, and MEDLINE. Articles that discussed alternatives to the conventional QALY were included. Alternatives were characterized by type, data availability, calculation burden, and overall implementation feasibility. The subset of feasible alternatives, that is, sufficient data and methodology compatible with incorporation into common modeling approaches, were evaluated according to impact on incremental QALYs, incremental net monetary benefit (iNMB), intervention rankings, and proportion of interventions with a positive iNMB. RESULTS We identified 28 articles discussing 9 alternatives. Feasible alternatives were using patient preference (PP) data; equity weighting according to baseline utility, fair innings, or proportional QALY shortfall; and the equal value of life-years-gained approach. All alternatives affected the incremental QALY and iNMB outcomes, rankings, and proportion of interventions with a positive iNMB. The PP alternative had the largest and most consistent impact. The PP impact on the proportion of interventions with a positive iNMB, was in the negative direction. CONCLUSIONS Our work is the first comprehensive evaluation of proposed alternatives to the conventional QALY. We found robust literature but few options that were feasible to be implemented in current healthcare decision-making processes.
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Affiliation(s)
- Josh J Carlson
- Department of Pharmacy, University of Washington, Seattle, WA, USA.
| | | | - Eunice Kim
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Phoebe Wright
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - R Brett McQueen
- Department of Clinical Pharmacy, University of Colorado, CO, USA
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Who should be given priority for public funding? Health Policy 2020; 124:1108-1114. [PMID: 32651005 DOI: 10.1016/j.healthpol.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study explored if Koreans consider the type of disease, rarity, and availability of alternative treatments as priority criteria in limited healthcare resource allocation. MATERIALS AND METHODS A web-based survey was conducted with a representative sample of 3,482 Korean adults. Participants were divided into six cohorts, differing in terms of the disease being compared and the cost and benefits of the treatments. Each cohort was asked two questions: 1) How to allocate a fixed budget into each of the two groups (cancer vs non-cancer, rare vs common, no other treatments available vs several treatments available), all else being equal; 2) allocation choices when conditions of two groups differed. The McNemar test was used to assess changes in responses between the two questions. RESULTS Under the control condition, the majority chose to treat an even number of patients with cancer and non-cancer diseases, and preferred to treat common diseases and those with no alternative treatments. However, when the treatment effects or costs of two comparison groups changed, choice shifted toward more effective or less costly treatment. CONCLUSIONS While Koreans generally support the principle of health maximization, they also believe that priority should be given to diseases that previously did not have any treatments. However, no priority was given to cancer or rare diseases.
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Christensen H, Al-Janabi H, Levy P, Postma MJ, Bloom DE, Landa P, Damm O, Salisbury DM, Diez-Domingo J, Towse AK, Lorgelly PK, Shah KK, Hernandez-Villafuerte K, Smith V, Glennie L, Wright C, York L, Farkouh R. Economic evaluation of meningococcal vaccines: considerations for the future. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:297-309. [PMID: 31754924 PMCID: PMC7072054 DOI: 10.1007/s10198-019-01129-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 10/24/2019] [Indexed: 05/21/2023]
Abstract
In 2018, a panel of health economics and meningococcal disease experts convened to review methodologies, frameworks, and decision-making processes for economic evaluations of vaccines, with a focus on evaluation of vaccines targeting invasive meningococcal disease (IMD). The panel discussed vaccine evaluation methods across countries; IMD prevention benefits that are well quantified using current methods, not well quantified, or missing in current cost-effectiveness methodologies; and development of recommendations for future evaluation methods. Consensus was reached on a number of points and further consideration was deemed necessary for some topics. Experts agreed that the unpredictability of IMD complicates an accurate evaluation of meningococcal vaccine benefits and that vaccine cost-effectiveness evaluations should encompass indirect benefits, both for meningococcal vaccines and vaccines in general. In addition, the panel agreed that transparency in the vaccine decision-making process is beneficial and should be implemented when possible. Further discussion is required to ascertain: how enhancing consistency of frameworks for evaluating outcomes of vaccine introduction can be improved; reviews of existing tools used to capture quality of life; how indirect costs are considered within models; and whether and how the weighting of quality-adjusted life-years (QALY), application of QALY adjustment factors, or use of altered cost-effectiveness thresholds should be used in the economic evaluation of vaccines.
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Affiliation(s)
- Hannah Christensen
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK.
| | - Hareth Al-Janabi
- Health Economics Unit, University of Birmingham, Birmingham, B15 2TT, UK
| | - Pierre Levy
- Université Paris-Dauphine, PSL Research University, LEDa [LEGOS], 75775, Paris, France
| | - Maarten J Postma
- Department of Pharmacy, University Medical Center/University of Groningen, 9712 CP, Groningen, The Netherlands
- Department of Health Sciences, University Medical Center/University of Groningen, 9712 CP, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, University Medical Center/University of Groningen, 9712 CP, Groningen, The Netherlands
| | - David E Bloom
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Cambridge, MA, 02115, USA
| | - Paolo Landa
- Institute of Health Research, Medical School, University of Exeter, Exeter, EX1 2LU, UK
| | - Oliver Damm
- School of Public Health, Bielefeld University, 33615, Bielefeld, Germany
| | - David M Salisbury
- Centre on Global Health Security, Royal Institute of International Affairs, London, SW1Y 4LE, UK
| | | | | | | | | | | | - Vinny Smith
- Meningitis Research Foundation, Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK.
| | - Linda Glennie
- Meningitis Research Foundation, Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK
| | - Claire Wright
- Meningitis Research Foundation, Newminster House, 27-29 Baldwin Street, Bristol, BS1 1LT, UK
| | - Laura York
- Vaccine Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, 19426, USA
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Abstract
Achieving a rapid global decarbonization to stabilize the climate critically depends on activating contagious and fast-spreading processes of social and technological change within the next few years. Drawing on expert elicitation, an expert workshop, and a review of literature, which provides a comprehensive analysis on this topic, we propose concrete interventions to induce positive social tipping dynamics and a rapid global transformation to carbon-neutral societies. These social tipping interventions comprise removing fossil-fuel subsidies and incentivizing decentralized energy generation, building carbon-neutral cities, divesting from assets linked to fossil fuels, revealing the moral implications of fossil fuels, strengthening climate education and engagement, and disclosing greenhouse gas emissions information. Safely achieving the goals of the Paris Climate Agreement requires a worldwide transformation to carbon-neutral societies within the next 30 y. Accelerated technological progress and policy implementations are required to deliver emissions reductions at rates sufficiently fast to avoid crossing dangerous tipping points in the Earth’s climate system. Here, we discuss and evaluate the potential of social tipping interventions (STIs) that can activate contagious processes of rapidly spreading technologies, behaviors, social norms, and structural reorganization within their functional domains that we refer to as social tipping elements (STEs). STEs are subdomains of the planetary socioeconomic system where the required disruptive change may take place and lead to a sufficiently fast reduction in anthropogenic greenhouse gas emissions. The results are based on online expert elicitation, a subsequent expert workshop, and a literature review. The STIs that could trigger the tipping of STE subsystems include 1) removing fossil-fuel subsidies and incentivizing decentralized energy generation (STE1, energy production and storage systems), 2) building carbon-neutral cities (STE2, human settlements), 3) divesting from assets linked to fossil fuels (STE3, financial markets), 4) revealing the moral implications of fossil fuels (STE4, norms and value systems), 5) strengthening climate education and engagement (STE5, education system), and 6) disclosing information on greenhouse gas emissions (STE6, information feedbacks). Our research reveals important areas of focus for larger-scale empirical and modeling efforts to better understand the potentials of harnessing social tipping dynamics for climate change mitigation.
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Reckers-Droog V, van Exel J, Brouwer W. Equity Weights for Priority Setting in Healthcare: Severity, Age, or Both? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1441-1449. [PMID: 31806201 DOI: 10.1016/j.jval.2019.07.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Priority setting in healthcare can be guided by both efficiency and equity principles. The latter principle is often explicated in terms of disease severity and, for example, defined as absolute or proportional shortfall. These severity operationalizations do not explicitly consider patients' age, even though age may be inextricably related to severity and an equity-relevant characteristic. OBJECTIVE This study examines the relative strength of societal preferences for severity and age for informing allocation decisions in healthcare. METHODS We elicited preferences for severity and age in a representative sample of the public in The Netherlands (N = 1025) by applying choice tasks and person-trade-off tasks in a design in which severity levels and ages varied both separately and simultaneously between patient groups. We calculated person trade-off ratios and, in addition, applied ordinary least squares regression models to aid interpretation of the ratios when both severity and age varied. RESULTS Respondents attached a higher weight (median of ratios: 2.46-3.50) to reimbursing treatment for relatively more severely ill and younger patients when preferences for both were elicited separately. When preferences were elicited simultaneously, respondents attached a higher weight (median of ratios: 1.98 and 2.42) to reimbursing treatment for relatively younger patients, irrespective of patients' severity levels. Ratios varied depending on severity level and age and were generally higher when the difference in severity and age was larger between groups. CONCLUSIONS Our results suggest that severity operationalizations and equity weights based on severity alone may not align with societal preferences. Adjusting decision-making frameworks to reflect age-related societal preferences should be considered.
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Affiliation(s)
- Vivian Reckers-Droog
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands; Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands; Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands
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Cost-effectiveness of Balloon Kyphoplasty for Patients With Acute/Subacute Osteoporotic Vertebral Fractures in the Super-Aging Japanese Society. Spine (Phila Pa 1976) 2019; 44:E298-E305. [PMID: 30086080 DOI: 10.1097/brs.0000000000002829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A propensity score matching study. OBJECTIVE The aim of this study was to assess the cost-effectiveness of balloon kyphoplasty (BKP) in Japan. SUMMARY OF BACKGROUND DATA Osteoporotic vertebral fracture (OVF) is a common disease in elderly people. In Japan, the incidence of painful OVF in 2008 was estimated as 880,000, and approximately 40% of patients with painful OVF are hospitalized due to the severity of pain. Japan is the front runner among super-aged societies and rising health care costs are an economic problem. METHODS BKP and nonsurgical management (NSM) for acute/subacute OVF were performed in 116 and 420 cases, respectively. Quality-adjusted life years (QALY) and incremental costs were calculated on the basis of a propensity score matching study. QALY was evaluated using the SF-6D questionnaire. Finally, using a Markov model, incremental cost-effectiveness ratios (ICERs) were calculated for 71 matched cases. RESULTS In the comparison between BKP and NSM, mean patients age was 78.3 and 77.7 years, respectively (P = 0.456). The BKP procedure cost 402,988 JPY more than NSM and the gains in QALY at the 6-month follow-up were 0.153 and 0.120, respectively (difference = 0.033). ICERs for 3 and 20 years were 4,404,158 JPY and 2,416,406 JPY, respectively. According to sensitivity analysis, ICERs ranged from 652,181 JPY to 4,896,645 JPY (4418-33,168 GBP). CONCLUSION This study demonstrated that BKP is a cost-effective treatment option for OVF in Japan. However, the effect might be blunted in patients aged > 80 years. Further research is necessary to elucidate the cost-effectiveness of BKP in this population. LEVEL OF EVIDENCE 4.
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Lal A, Mohebi M, Sweeney R, Moodie M, Peeters A, Carter R. Equity Weights for Socioeconomic Position: Two Methods-Survey of Stated Preferences and Epidemiological Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:247-253. [PMID: 30711071 DOI: 10.1016/j.jval.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is an implicit equity approach in cost-effectiveness analysis that values health gains of socioeconomic position groups equally. An alternative approach is to integrate equity by weighting quality-adjusted life-years according to the socioeconomic position group. OBJECTIVES To use two approaches to derive equity weights for use in cost-effectiveness analysis in Australia, in contexts in which the use of the traditional nonweighted quality-adjusted life-years could increase health inequalities between already disadvantaged groups. METHODS Equity weights derived using epidemiological data used burden of disease and mortality data by Socio-Economic Indexes for Areas quintiles from the Australian Institute of Health and Welfare. Two ratios were calculated comparing quintile 1 (lowest) to the total Australian population, and comparing quintile 1 to quintile 5 (highest). Preference-based weights were derived using a discrete choice experiment survey (n = 710). Respondents chose between two programs, with varying gains in life expectancy going to a low- or a high-income group. A probit model incorporating nominal values of the difference in life expectancy was estimated to calculate the equity weights. RESULTS The epidemiological weights ranged from 1.2 to 1.5, with larger weights when quintile 5 was the denominator. The preference-based weights ranged from 1.3 (95% confidence interval 1.2-1.4) to 1.8 (95% confidence interval 1.6-2.0), with a tendency for increasing weights as the gains to the low-income group increased. CONCLUSIONS Both methods derived plausible and consistent weights. Using weights of different magnitudes in sensitivity analysis would allow the appropriate weight to be considered by decision makers and stakeholders to reflect policy objectives.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia; Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.
| | - Mohammadreza Mohebi
- Biostatics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Marjory Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia; Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Rob Carter
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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Richardson J, Schlander M. Health technology assessment (HTA) and economic evaluation: efficiency or fairness first. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2018; 7:1557981. [PMID: 30651941 PMCID: PMC6327925 DOI: 10.1080/20016689.2018.1557981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 05/27/2023]
Abstract
The economic evaluation which supports Health Technology Assessment (HTA) should inform policy makers of the value to society conferred by a given allocation of resources. However, neither the theory nor practise of economic evaluation satisfactorily reflect social values. Both are primarily concerned with efficiency, commonly conceptualised as the maximisation of utility or quality adjusted life years (QALYs). The focus is upon the service and the benefits obtained from it. This has resulted in an evaluation methodology which discriminates against groups and treatments which the population would like to prioritise. This includes high cost treatments for patients with rare diseases. In contrast with prevailing methods, there is increasing evidence that the public would prefer a fairness-focused framework in which the service was removed from centre stage and replaced by the patient. However methods for achieving fairness are ad hoc and under-developed. The article initially reviews the theory of economic evaluation and argues that its focus upon individual utility and efficiency as defined by the theory omits potentially important social values. Some empirical evidence relating to population values is presented and four studies by the first author are reviewed. These indicate that when people adopt the social perspective of a citizen they have a preference for sharing the health budget in a way which does not exclude patients who require services that are not cost effective, such as orphan medicinal products (OMP's) and treatments for patients with ultra-rare diseases (URD's).
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ) & University of Heidelberg, Heidelberg, Germany
- Institute for Innovation and Valuation in Health Care, Wiesbaden, Germany
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Richardson J, Iezzi A, Maxwell A. Sharing and the Provision of "Cost-Ineffective" Life-Extending Services to Less Severely Ill Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:951-957. [PMID: 30098673 DOI: 10.1016/j.jval.2017.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/07/2017] [Accepted: 12/05/2017] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cost-utility analysis prioritizes services using cost, life-years, and the health state utility of the life-years. Nevertheless, a significant body of evidence suggests that the public would prefer more variables to be considered in decision making and at least some sharing of the budget with services for severe conditions that are not cost-effective because of their high cost. OBJECTIVES To examine whether this preference for sharing persists for less severe conditions when both cost effectiveness and illness severity would indicate that resources should be allocated to other services. METHODS Survey respondents were asked to divide a budget between two patients facing life-threatening illnesses. The severity of the illnesses differed and the price of treatment was varied. RESULTS Sharing occurred in all scenarios including scenarios in which the illness was less severe and services were not cost-effective. Results are consistent with behavior commonly observed in other contexts. CONCLUSIONS Results suggest that sharing per se is important and that the public would support some funding of cost-ineffective services for less severe health problems.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Victoria, Australia
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Zhou A, Yousem DM, Alvin MD. Cost-Effectiveness Analysis in Radiology: A Systematic Review. J Am Coll Radiol 2018; 15:1536-1546. [PMID: 30057243 DOI: 10.1016/j.jacr.2018.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Cost-effectiveness analyses (CEAs) have become more prevalent in radiology. However, the lack of standard methodology may lead to conflicting conclusions on the cost-effectiveness of an imaging modality and hinder CEA-based policy recommendations. This study reviews recent CEAs to identify areas of methodological variation, explore their impact on interpretation, and discuss optimal strategies for performing CEAs in radiology. METHODS We performed a systematic review for cost-utility analyses in radiology from 2013 to 2017. Cost and quality-of-life methods were analyzed and compared using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Eighty cost-utility studies met our inclusion criteria. A payer perspective was the most common (70%) and hospital perspective the least common (5%). Fourteen studies (17.5%) did not report perspective, and 12 (15%) reported a perspective inconsistent with their performed analysis. Cost inclusion varied greatly between studies; adverse effects of imaging (20.5%) and hospitalization (34.6%) were the least frequently included direct costs. Studies that measured their own utilities most commonly used the EuroQol-5D and Short Form-6D questionnaires; however, most studies (80%) cited utilities from previous literature. Seventy-two studies (90%) used willingness-to-pay thresholds, and 30 used cost-effectiveness acceptability curves (41.7%). CONCLUSION We observed statistically significant methodological variation indicating the need for a standardized, accurate means of performing and presenting CEAs within radiology. We make several recommendations to address key problems regarding study perspective, cost inclusion, and use of willingness-to-pay thresholds. Further work is required to ensure comparability and transparency between studies such that policymakers are properly informed when utilizing CEA results.
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Affiliation(s)
- Alice Zhou
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland
| | - Matthew D Alvin
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland.
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Reckers-Droog V, van Exel J, Brouwer W. Who should receive treatment? An empirical enquiry into the relationship between societal views and preferences concerning healthcare priority setting. PLoS One 2018; 13:e0198761. [PMID: 29949648 PMCID: PMC6021057 DOI: 10.1371/journal.pone.0198761] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Policy makers increasingly need to prioritise between competing health technologies or patient populations. When aiming to align allocation decisions with societal preferences, knowledge and operationalisation of such preferences is indispensable. This study examines the distribution of three views on healthcare priority setting in the Netherlands, labelled "Equal right to healthcare", "Limits to healthcare", and "Effective and efficient healthcare", and their relationship with preferences in willingness to trade-off (WTT) exercises. METHODS A survey including four reimbursement scenarios was conducted in a representative sample of the adult population in the Netherlands (n = 261). Respondents were matched to one of the three views based on their agreement with 14 statements on principles for resource allocation. We tested for WTT differences between respondents with different views and applied logit regression models for examining the relationship between preferences and background characteristics, including views. RESULTS Nearly 65% of respondents held the view "Equal right to healthcare", followed by "Limits to healthcare" (22.5%), and "Effective and efficient healthcare" (7.1%). Most respondents (75.9%) expressed WTT in at least one scenario and preferred gains in quality of life over life expectancy, maximising gains over limiting inequality, treating children over elderly, and those with adversity over those with an unhealthy lifestyle. Various background characteristics, including the views, were associated with respondents' preferences. CONCLUSIONS Most respondents held an egalitarian view on priority setting, yet the majority was willing to prioritise regardless of their view. Societal views and preferences concerning healthcare priority setting are related. However, respondents' views influence preferences differently in different reimbursement scenarios. As societal views and preferences are heterogeneous and may conflict, aligning allocation decisions with societal preferences remains challenging and any decision may be expected to receive opposition from some group in society.
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Affiliation(s)
- Vivian Reckers-Droog
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
| | - Job van Exel
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands.,Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, the Netherlands
| | - Werner Brouwer
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands
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Richardson J, Iezzi A, Maxwell A. Does a patient's health potential affect the social valuation of health services? PLoS One 2018; 13:e0192585. [PMID: 29689055 PMCID: PMC5918170 DOI: 10.1371/journal.pone.0192585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/27/2018] [Indexed: 11/18/2022] Open
Abstract
Background Patients with a permanent impairment may be unable to reach full health. Consequently health services which cure illnesses which are unrelated to the impairment may increase health less than services for patients with no impairment. While it has been argued that this should not lead to discrimination against impaired patients there is little evidence to determine whether this equity-efficiency trade-off is consistent with social values. Objectives To measure the effect of permanent impairment upon the social valuation of services for unrelated illnesses. Methods Social valuations of services for illnesses associated with mobility, depression or pain were assessed and compared for patients with and without a permanent impairment using the Relative Social Willingness to Pay (RS-WTP) instrument. The maximum valuation of services for impaired patients was also compared with the maximum utility which could be gained when utility was measured using three multi attribute utility instruments. Results Curing the illness of impaired patients was valued 8–11 percent less than the cure of patients with no impairment. Discrimination decreased as the severity of the illness increased. Valuation of health states using the utility instruments implied significantly greater discrimination than the social valuations using the RS-WTP instrument. Conclusions Health services are valued less highly when a patient’s health potential is impaired. However discrimination is significantly less than would occur if the value of the services were limited to the value of the health state causing the impairment. The argument for disregarding a patient’s limited health potential when resources are allocated therefore receives some support from social valuations but the case for completely equal treatment depends upon additional ethical arguments.
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Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic, Australia
- * E-mail:
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic, Australia
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Lal A, Siahpush M, Moodie M, Peeters A, Carter R. Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences. PHARMACOECONOMICS - OPEN 2018; 2:43-51. [PMID: 29464669 PMCID: PMC5820237 DOI: 10.1007/s41669-017-0036-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The trade-off that society is willing to make to promote a more equitable distribution of health can be represented as a social welfare function (SWF). SWFs are an economic construct that can be used to illustrate concerns for total health with aversion to inequalities between socioeconomic groups. OBJECTIVE This study used people's preferences to estimate the shapes of health-related SWFs (HRSWFs). We tested the suitability of this method to derive equity weights. METHODS A questionnaire was used to elicit preferences concerning trade-offs between the total level of health and its distribution among two socioeconomic groups. The participant group was a sample of convenience that included a mix of health researchers, academics, clinicians, managers, public servants and research students. The data collected were used to develop HRSWFs with a constant elasticity of substitution. The weight was calculated using the marginal rate of substitution. RESULTS A marginal health gain to the lowest socioeconomic position (SEP) group was valued 14.1-81.4 times more than a marginal health gain to the high SEP group. CONCLUSIONS Our results provide evidence to support the idea that the public may be willing to make trade-offs between efficiency and equity, and that they value health gains differently depending on which socioeconomic group receives the health gain. Further evidence is required before such indicative weights have practical value.
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Affiliation(s)
- Anita Lal
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Mohammad Siahpush
- Department of Health Promotion, Social & Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Marjory Moodie
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Anna Peeters
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Robert Carter
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Lal A, Moodie M, Peeters A, Carter R. Inclusion of equity in economic analyses of public health policies: systematic review and future directions. Aust N Z J Public Health 2017; 42:207-213. [PMID: 28898490 DOI: 10.1111/1753-6405.12709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/01/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess current approaches to inclusion of equity in economic analysis of public health interventions and to recommend best approaches and future directions. METHODS We conducted a systematic review of studies that have used socioeconomic position (SEP) in cost-effectiveness analyses. Studies were identified using MedLine, EconLit and HEED and were evaluated based on their SEP specific inputs and methods of quantification of the health and financial inequalities. RESULTS Twenty-nine relevant studies were identified. The majority of studies comparing two or more interventions left interpretation of the size of the health and financial inequality differences to the reader. Newer approaches include: i) use of health inequality measures to quantify health inequalities; ii) inclusion of financial impacts, such as out-of-pocket expenditures; and iii) use of equity weights. The challenge with these approaches is presenting results that policy makers can easily interpret. CONCLUSIONS Using CEA techniques to generate new information about the health equity implications of alternative policy options has not been widely used, but should be considered to inform future decision making. Implications for public health: Inclusion of equity in economic analysis would facilitate a more nuanced comparison of interventions in relation to efficiency, equity and financial impact.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Victoria
| | - Marjory Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Victoria
| | - Anna Peeters
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Victoria
| | - Rob Carter
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Victoria
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Farmakas A, Theodorou M, Galanis P, Karayiannis G, Ghobrial S, Polyzos N, Papastavrou E, Agapidaki E, Souliotis K. Public engagement in setting healthcare priorities: a ranking exercise in Cyprus. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2017; 15:16. [PMID: 28808427 PMCID: PMC5551077 DOI: 10.1186/s12962-017-0078-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. METHODS The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. RESULTS It was revealed that the "severity of the disease" and the "age of the patient" were the key prioritization criteria. Participants assigned the smallest relative value to the criterion "healthy lifestyle". More precisely, participants older than 35 years old assigned higher relative importance to "age", while younger participants to the "severity of the disease". The "healthy lifestyle" criterion was assigned to the lowest relative importance to by all participants. CONCLUSION In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public's participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance.
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Affiliation(s)
- Antonis Farmakas
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mamas Theodorou
- Faculty of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
| | - Petros Galanis
- Research Associate Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Athens, Greece
| | | | | | - Nikos Polyzos
- Department of Social Administration and Political Science, Democritus University of Thrace, Komotini, Greece
| | | | - Eirini Agapidaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, 25 Alexandroupoleos st., Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
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Wouters S, van Exel N, Rohde K, Vromen J, Brouwer W. Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning. Soc Sci Med 2017; 181:158-167. [DOI: 10.1016/j.socscimed.2017.03.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
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43
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Fragoulakis V, Mitropoulou C, Katelidou D, van Schaik RH, Maniadakis N, Patrinos GP. Performance Ratio Based Resource Allocation Decision-Making in Genomic Medicine. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2017; 21:67-73. [PMID: 28118098 DOI: 10.1089/omi.2016.0161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In modern healthcare systems, the available resources may influence the morbidity, mortality, and-consequently-the level of healthcare provided in every country. This is of particular interest in developing countries where the resources are limited and must be spent wisely to address social justice and the right for equal access in healthcare services by all the citizens in economically viable terms. In this light, the current allocation is, in practice, inefficient and rests mostly on each country's individual political and historical context and, thus, does not always incorporate decision-making enabled by economic models. In this study, we present a new economic model, specifically for resource allocation for genomic medicine, based on performance ratio, with potential applications in diverse healthcare sectors, which are particularly appealing for developing countries and low-resource environments. The model proposes a new method for resource allocation taking into account (1) the size of innovation of a new technology, (2) the relative effectiveness in comparison with social preferences, and (3) the cost of the technology, which permits the measurement of effectiveness to be determined differently in the context of a specific disease and then to be expressed in a relative form using a common performance ratio. The present work expands on previous work for innovation in economic models pertaining to genomic medicine and supports translational science.
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Affiliation(s)
- Vasilios Fragoulakis
- 1 Department of Pharmacy, University of Patras School of Health Sciences , Patras, Greece .,2 Department of Health Services Management, National School of Public Health , Athens, Greece
| | - Christina Mitropoulou
- 3 Erasmus MC , Department of Clinical Chemistry, Rotterdam, the Netherlands .,4 The Golden Helix Foundation , London, United Kingdom
| | | | - Ron H van Schaik
- 3 Erasmus MC , Department of Clinical Chemistry, Rotterdam, the Netherlands
| | - Nikolaos Maniadakis
- 2 Department of Health Services Management, National School of Public Health , Athens, Greece
| | - George P Patrinos
- 1 Department of Pharmacy, University of Patras School of Health Sciences , Patras, Greece
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van de Wetering EJ, van Exel J, Brouwer WBF. The Challenge of Conditional Reimbursement: Stopping Reimbursement Can Be More Difficult Than Not Starting in the First Place! VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:118-125. [PMID: 28212952 DOI: 10.1016/j.jval.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/29/2016] [Accepted: 09/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Conditional reimbursement of new health technologies is increasingly considered as a useful policy instrument. It allows gathering more robust evidence regarding effectiveness and cost-effectiveness of new technologies without delaying market access. Nevertheless, the literature suggests that ending reimbursement and provision of a technology when it proves not to be effective or cost-effective in practice may be difficult. OBJECTIVES To investigate how policymakers and the general public in the Netherlands value removing a previously reimbursed treatment from the basic benefits package relative to not including a new treatment. METHODS To investigate this issue, we used discrete-choice experiments. Mixed multinomial logit models were used to analyze the data. Compensating variation values and changes in probability of acceptance were calculated for withdrawal of reimbursement. RESULTS The results show that, ceteris paribus, both the general public (n = 1169) and policymakers (n = 90) prefer a treatment that is presently reimbursed over one that is presently not yet reimbursed. CONCLUSIONS Apparently, ending reimbursement is more difficult than not starting reimbursement in the first place, both for policymakers and for the public. Loss aversion is one of the possible explanations for this result. Policymakers in health care need to be aware of this effect before engaging in conditional reimbursement schemes.
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Affiliation(s)
- E J van de Wetering
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Economics, Erasmus University Rotterdam, The Netherlands.
| | - Werner B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Wouters S, van Exel J, Baker R, B F Brouwer W. Priority to End of Life Treatments? Views of the Public in the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:107-117. [PMID: 28212951 DOI: 10.1016/j.jval.2016.09.544] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/23/2016] [Accepted: 09/01/2016] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Recent debates in the Netherlands on health care priority setting have focused on the relative value of gains generated by life-extending medicines for people with a terminal illness, mostly new cancer drugs. These treatments are generally expensive, provide relatively small health gains, and therefore usually do not meet common cost per QALY thresholds. Nevertheless, these drugs may be provided under the assumption that there is public support for making a special case for treatments for people with a terminal illness. This study investigated the views of the public in the Netherlands on a range of equity and efficiency considerations relevant to priority setting and examines whether there is public support for making such a special case. METHODS Using Q methodology, three viewpoints on important principles for priority setting were identified. Data were collected through ranking exercises conducted by 46 members of the general public in the Netherlands, including 11 respondents with personal experience with cancer. RESULTS Viewpoint 1 emphasized that people have equal rights to healthcare and opposed priority setting on any ground. Viewpoint 2 emphasized that the care for terminal patients should at all times respect the patients' quality of life, which sometimes means refraining from invasive treatments. Viewpoint 3 had a strong focus on effective and efficient care and had no moral objection against priority setting under certain circumstances. CONCLUSIONS Overall, we found little public support for the assumption that health gains in terminally ill patients are more valuable than those in other patients. This implies that the assumption that society is prepared to pay more for health gains in people who have only a short period of lifetime left does not correspond with societal preferences in the Netherlands.
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Affiliation(s)
- Sofie Wouters
- 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.
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Werner B F Brouwer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Skedgel C. The prioritization preferences of pan-Canadian Oncology Drug Review members and the Canadian public: a stated-preferences comparison. ACTA ACUST UNITED AC 2016; 23:322-328. [PMID: 27803596 DOI: 10.3747/co.23.3033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The pan-Canadian Oncology Drug Review (pcodr) is responsible for making coverage recommendations to provincial and territorial drug plans about cancer drugs. Within the pcodr process, small groups of experts (including public representatives) consider the characteristics of each drug and make a funding recommendation. It is important to understand how the values and preferences of those decision-makers compare with the values and preferences of the citizens on whose behalf they are acting. In the present study, stated preference methods were used to elicit prioritization preferences from a representative sample of the Canadian public and a small convenience sample of pcodr committee members. The results suggested that neither group sought strictly to maximize quality-adjusted life year (qaly) gains and that they were willing to sacrifice some efficiency to prioritize particular patient characteristics. Both groups had a significant aversion to prioritizing older patients, patients in good pre-treatment health, and patients in poor post-treatment health. Those results are reassuring, in that they suggest that pcodr decision-maker preferences are consistent with those of the Canadian public, but they also imply that, like the larger public, decision-makers might value health gains to some patients more or less highly than the same gains to others. The implicit nature of pcodr decision criteria means that the acceptability or limits of such differential valuations are unclear. Likewise, there is no guidance as to which potential equity factors-for example, age, initial severity, and so on-are legitimate and which are not. More explicit guidance could improve the consistency and transparency of pcodr recommendations.
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Affiliation(s)
- C Skedgel
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, U.K.;; School of Pharmacy, Dalhousie University, Halifax, NS
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From representing views to representativeness of views: Illustrating a new (Q2S) approach in the context of health care priority setting in nine European countries. Soc Sci Med 2016; 166:205-213. [DOI: 10.1016/j.socscimed.2016.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/04/2016] [Accepted: 08/20/2016] [Indexed: 11/18/2022]
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SCIENTIFIC AND SOCIAL VALUE JUDGMENTS FOR ORPHAN DRUGS IN HEALTH TECHNOLOGY ASSESSMENT. Int J Technol Assess Health Care 2016; 32:218-232. [PMID: 27624559 DOI: 10.1017/s0266462316000416] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We explore how broader aspects of a treatment's value and the impact of the condition on patients not captured by routine health technology assessment (HTA) methods using clinical and economic evidence, defined as "other considerations," may influence HTA processes in different settings. METHODS Countries included were England, Scotland, Sweden, and France. Data sources were the publicly available reports on HTA recommendations. Ten drugs with European Medicines Agency orphan designation and appraised in England were selected. Qualitative thematic analysis was used to systematically identify and code all "other considerations" based on a previously developed methodological framework, which also coded whether it was provided by stakeholders, and how it influenced the decision. RESULTS A classification framework of scientific and social value judgments was developed and used throughout the study. A total of 125 "other considerations" were identified and grouped into ten subcategories based on the information provided. Eighteen to 100 percent of these, depending on the agency, were put forward as one of the main reasons for the final decision potentially contributing to accepting a higher incremental cost-effectiveness ratio or uncertain evidence. Some of these were nonquantified or nonelicited and pertained to the assessor's judgment. A taxonomy of these value judgments was created to be used in future cases. Results also contributed to better defining the determinants of social value and improving accountability for reasonableness. CONCLUSIONS The systematic identification of the scientific and social value judgments enables to better understanding the dimensions of value, which can be used to improve their transparency and consistent use across decisions and settings.
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Fragoulakis V, Mitropoulou C, van Schaik RH, Maniadakis N, Patrinos GP. An Alternative Methodological Approach for Cost-Effectiveness Analysis and Decision Making in Genomic Medicine. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2016; 20:274-82. [DOI: 10.1089/omi.2016.0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Vasilios Fragoulakis
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Christina Mitropoulou
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron H. van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - George P. Patrinos
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
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van de Wetering EJ, van Exel NJA, Rose JM, Hoefman RJ, Brouwer WBF. Are some QALYs more equal than others? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:117-27. [PMID: 25479937 DOI: 10.1007/s10198-014-0657-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/11/2014] [Indexed: 05/15/2023]
Abstract
Including societal preferences in allocation decisions is an important challenge for the health care sector. Here, we present results of a phased discrete choice experiment investigating the impact of various attributes on respondents' preferences for distribution of health and health care. In addition to the renowned equity principles severity of illness (operationalized as initial health) and fair innings (operationalized as age), some characteristics of beneficiaries (culpability and having dependents) and the disease (rarity) were included in the choice experiment. We used a nested logit model to analyse the data. We found that all selected attributes significantly influenced respondents' choices. The phased inclusion showed that additional attributes affected respondents' preferences for previously-included attributes and reduced unobserved variance. Although not all these attributes may be considered relevant for decision making from a normative perspective, including them in choice experiments contributes to our understanding of societal preferences for each single attribute.
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Affiliation(s)
- E J van de Wetering
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands.
| | - N J A van Exel
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands
| | - J M Rose
- Institute of Transport and Logistics Studies, The University of Sydney, Sydney, Australia
| | - R J Hoefman
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands
| | - W B F Brouwer
- Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, DR, 3000, The Netherlands
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