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Walter N, Hierl K, Rupp M, Alt V. Basics of health economics for clinical trials in orthopaedic trauma. Injury 2023; 54 Suppl 5:110878. [PMID: 37923505 DOI: 10.1016/j.injury.2023.110878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 11/07/2023]
Abstract
With the rise in global healthcare spending, medical decision-making is increasingly based on health economics outcomes. This narrative review aims to provide an overview of cost-effectiveness analysis (CEA) and cost-utility analysis (CUA), including their advantages and limitations, and outline practical aspects for implementing health economics in clinical trials for orthopaedic trauma. Both CEA and CUA offer several advantages. Firstly, they consider the costs as well as benefits of an intervention, providing a more comprehensive picture of its economic impact. Secondly, they provide a clear and straightforward metric for comparing interventions, which can help decision-makers make informed choices. However, there are methodological shortcomings that must be acknowledged, such as the lack of standardized instruments for assessing health utility measures, which can result in a wide range of cost-benefit ratios. In addition, a consensus on the willingness-to-pay threshold still needs to be reached to develop decision rules for cost-effectiveness similar to clinical effectiveness. Methods such as CEA and CUA should be incorporated into clinical trials in orthopaedic trauma research. Practical aspects for this include planning in advance, preferably in cooperation with a health economist. Selecting appropriate outcome measures is crucial, and both the medical effects of interventions and quality of life instruments should be carefully chosen to ensure comparability with previous studies. Additionally, the potential impact on clinical practice and healthcare policies should be considered. Direct as well as indirect costs should be assessed, and quality assurance with well-established checklists should be confirmed.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany; Department of Psychosomatic Medicine, University Hospital Regensburg, Germany.
| | - Katja Hierl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
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Roy Chowdhury S, Bohara AK. Preferences of cancer patients as a guide to cancer prevention: a retrospective willingness to pay study in Nepal. Public Health 2023; 214:42-49. [PMID: 36495725 DOI: 10.1016/j.puhe.2022.10.022] [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: 03/25/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In developing countries, like Nepal, with no population-based cancer registry and low level of awareness, it is difficult to communicate the significance of cancer preventative measures to the general population. Only patients, who have faced or facing the economic and mental burden of cancer, can better understand the importance of early diagnosis. This led us to study the retrospective preference of cancer patients in valuing an annual comprehensive cancer screening program in Nepal. STUDY DESIGN This is a primary survey-based study of 600 diagnosed cancer patients (aged 18+ years) randomly sampled from five hospitals of Nepal during December 2015-February 2016. METHODS Using the contingent valuation estimation methods, we modelled patients' willingness to pay (WTP) for early cancer screening through the Structural Equation Modelling framework. RESULTS About 59% of our sampled patients did not receive education and 65% earned below $100/month. Among other findings, we saw that the Risk of re-occurrence impacted WTP through two opposing channels. The direct effect of Risk of re-occurrence on WTP was positive (β = 0.20; p < 0.05), but higher the risk of cancer relapses, the higher was the Pessimism among patients, which indirectly impacted WTP negatively (β = -0.16; p < 0.1). In addition, we found the effect of Income on WTP to be positive (β = 0.15; p < 0.05), whereas, one belonging to the backward Dalit section of the society had lower WTP for screening. CONCLUSION Cancer patients value the importance of early diagnosis with multiple psychosocial factors impacting this preference. This direct account of patients could be used as evidence in policymaking.
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Affiliation(s)
| | - A K Bohara
- Department of Economics, University of New Mexico, Albuquerque, USA.
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Floyd SB, Oostdyk A, Cozad M, Brooks JM, Siffri P, Burnikel B. Assessing the Patient-Perceived Monetary Value of Patient-Reported Outcome Improvement for Patients With Chronic Knee Conditions. J Patient Cent Res Rev 2021; 8:98-106. [PMID: 33898641 PMCID: PMC8060045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
PURPOSE The high cost of orthopaedic care has attracted criticism in the current value-based health care environment. The objective of this work was to assess the properties of a willingness to pay (WTP)-based approach to estimate the monetary value that patients place on health improvements in chronic knee conditions following orthopaedic treatment. METHODS A sample of patients with a chronic knee condition were surveyed between January and May of 2018 at a large orthopaedic practice. Each patient provided their WTP for restoration to ideal knee health and completed the Single Assessment Numerical Evaluation (SANE) to describe their baseline knee state. Average WTP was calculated for the total sample and stratified by income, age, and baseline SANE (for which 0 is the worst and 100 is the best) levels. The patient-perceived monetary value of each unit of SANE improvement was assessed. RESULTS The study sample included 86 patients seeking orthopaedic care for a chronic knee condition. Mean baseline SANE score was 45.5 (standard deviation: 25.0). Mean WTP to obtain ideal knee function from baseline was $18,704 (standard deviation: $18,040). For the full sample, patients valued a 1-unit improvement in SANE score at $291.1 (β: 291.1; P<0.05). The amount of money patients were willing to pay to achieve ideal knee function varied with age, income, and baseline knee state. CONCLUSIONS Patients appear to highly value improvement in chronic knee conditions. Willingness-to-pay survey results appear to track expected variation in patient outcome valuation by income and baseline knee condition and could be a valuable approach to assess value-based care in orthopaedics.
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Affiliation(s)
- Sarah B Floyd
- Department of Public Health Sciences, Clemson University, Clemson, SC
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
| | - Alicia Oostdyk
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Melanie Cozad
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - John M Brooks
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Paul Siffri
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC
| | - Brian Burnikel
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC
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Deng Q, Zhang SP, Deng YX, Liu FF, Shi W, Xie HF, Xiao Y, Huang YX, Li J. Willingness-to-Pay and Benefit-Cost Analysis of IPL for Rosacea Treatment: A Cross-Sectional Study in China. Patient Prefer Adherence 2020; 14:1843-1852. [PMID: 33116428 PMCID: PMC7553264 DOI: 10.2147/ppa.s271859] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/09/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Intense pulsed light (IPL), as a therapeutic approach for rosacea, had advantage in removing erythema and telangiectasia and was gradually accepted by rosacea patients, but there have been few studies on economic evaluation of this therapy. PURPOSE This study aimed to detect willingness-to-pay (WTP) of IPL treatment for rosacea and to conduct a benefit-cost analysis (BCA) among the Chinese population, so as to provide an economic reference for doctors to make treatment decisions. MATERIALS AND METHODS An observational, cross-sectional study assessed respondent's demographic characteristics and willingness-to-pay (WTP) of IPL and rosacea patients' clinical data and Dermatology Life Quality Index (DLQI). WTP was obtained by contingent valuation (CV) method. In brief, contrast figures of three cases treated with IPL (Case1, Case2, and Case3 represented the increasing severity of rosacea) were showed and WTP was inquired. The costs were obtained according the market and compared with WTP (benefits) to get a benefit-cost ratio (BCR). Predictors of cost-effective WTP were identified using the multivariable logistic regression model. RESULTS A total of 303 rosacea patients and 202 controls were included in the study. The average cost of a single IPL treatment for rosacea was USD 208.04 in Changsha, China. The mean WTP for Case 1, Case 2, and Case 3 was USD 201.57, 214.64, and 221.74, respectively. WTP was statistically lower for Case 1 than that for Case 2 or Case 3 (P<0.05). The BCRs were 0.85, 1.03, and 1.06 for Case 1, Case 2, and Case 3, respectively. WTP is significantly associated with household monthly income, previous treatment cost, and DLQI after adjustments for demographic characteristics (P<0.05). CONCLUSION IPL is an acceptable treatment for rosacea with moderate to severe erythema. For patients with relatively high income or severely impaired quality of life, IPL is an economically feasible therapy and deserves to be recommended.
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Affiliation(s)
- Qing Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
| | - Shu-ping Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
| | - Yu-Xuan Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
| | - Fang-fen Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
| | - Hong-fu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
- Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, People’s Republic of China
| | - Yi Xiao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
| | - Ying-Xue Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
- Correspondence: Ying-Xue Huang; Ji Li Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan410008, People’s Republic of ChinaTel +86 186 2755 6448; +86 139 7512 3658Fax +86 0731 8432 8888 Email ;
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan410008, People’s Republic of China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, Hunan, People's Republic of China
- Key Laboratory of Molecular Radiation Oncology Hunan Province, Changsha, People’s Republic of China
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Mbada CE, Mamud SO, Odole AC, Omole JO, Oyewole OO, Ogundele AO, Fatoye FA. Development and clinimetric testing of willingness to pay tool for physiotherapy. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1627703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Chidozie E. Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sunday O. Mamud
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adesola C. Odole
- Department of Physiotherapy, College of Medicine, University of Ibadan, Nigeria
| | - John O. Omole
- Physiotherapy Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olufemi O. Oyewole
- Physiotherapy Department, Olabisi Onabanjo University teaching Hospital, Sagamu, Nigeria
| | - Abiola O. Ogundele
- Physiotherapy Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Francis A. Fatoye
- Department of Health Profession Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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Nwachukwu BU, Eliasberg CD, Hamid KS, Fu MC, Bach BR, Allen AA, Albert TJ. Contingent Valuation Studies in Orthopaedic Surgery: A Health Economic Review. HSS J 2018; 14:314-321. [PMID: 30258339 PMCID: PMC6148581 DOI: 10.1007/s11420-018-9610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A greater emphasis on providing high-value orthopaedic interventions has resulted in increased health economic reporting. The contingent-valuation method (CVM) is used to determine consumer valuation of the benefits provided by healthcare interventions. CVM is an important value-based health economic tool that is underutilized in orthopaedic surgery. QUESTIONS/PURPOSES The purpose of this study was to (1) identify previously published CVM studies in the orthopaedic literature, (2) assess the methodologies used for CVM research, and (3) understand how CVM has been used in the orthopaedic cost-benefit analysis framework. METHODS A systematic review of the literature using the MEDLINE database was performed to compile CVM studies. Search terms incorporated the phrase willingness to pay (WTP) or willingness to accept (WTA) in combination with orthopaedic clinical key terms. Study methodology was appraised using previously defined empirical and conceptual criteria for CVM studies. RESULTS Of the 160 studies retrieved, 22 (13.8%) met our inclusion criteria. The economics of joint arthroplasty (n = 6, 27.3%) and non-operative osteoarthritis care (n = 4, 18.2%) were the most common topics. Most studies used CVM for pricing and/or demand forecasting (n = 16, 72.7%); very few studies used CVM for program evaluation (n = 6). WTP was used in all included studies, and one study used both WTP and WTA. Otherwise, there was little consistency among included studies in terms of CVM methodology. Open-ended questioning was used by only ten studies (45.5%), a significant number of studies did not perform a sensitivity analysis (n = 9, 40.9%), and none of the studies accounted for the risk preference of subjects. Only two of the included studies applied CVM within a cost-benefit analysis framework. CONCLUSION CVM is not commonly reported in orthopaedic surgery and is seldom used in the context of cost-benefit analysis. There is wide variability in the methods used to perform CVM. We propose that CVM is an appropriate and underappreciated method for understanding the value of orthopaedic interventions. Increased attention should be paid to consumer valuations for orthopaedic interventions.
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Affiliation(s)
- Benedict U. Nwachukwu
- 0000 0001 2285 8823grid.239915.5Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Claire D. Eliasberg
- 0000 0001 2285 8823grid.239915.5Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kamran S. Hamid
- 0000 0001 0705 3621grid.240684.cDepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA
| | - Michael C. Fu
- 0000 0001 2285 8823grid.239915.5Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Bernard R. Bach
- 0000 0001 0705 3621grid.240684.cDepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA
| | - Answorth A. Allen
- 0000 0001 2285 8823grid.239915.5Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Todd J. Albert
- 0000 0001 2285 8823grid.239915.5Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Fawsitt CG, Bourke J, Murphy A, McElroy B, Lutomski JE, Murphy R, Greene RA. A Cost-Benefit Analysis of Two Alternative Models of Maternity Care in Ireland. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:785-794. [PMID: 28828573 PMCID: PMC5701951 DOI: 10.1007/s40258-017-0344-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND The Irish government has committed to expand midwifery-led care alongside consultant-led care nationally, although very little is known about the potential net benefits of this reconfiguration. OBJECTIVES To formally compare the costs and benefits of the major models of care in Ireland, with a view to informing priority setting using the contingent valuation technique and cost-benefit analysis. METHODS A marginal payment scale willingness-to-pay question was adopted from an ex ante perspective. 450 pregnant women were invited to participate in the study. Cost estimates were collected primarily, describing the average cost of a package of care. Net benefit estimates were calculated over a 1-year cycle using a third-party payer perspective. RESULTS To avoid midwifery-led care, women were willing to pay €821.13 (95% CI 761.66-1150.41); to avoid consultant-led care, women were willing to pay €795.06 (95% CI 695.51-921.15). The average cost of a package of consultant- and midwifery-led care was €1,762.12 (95% CI 1496.73-2027.51) and €1018.47 (95% CI 916.61-1120.33), respectively. Midwifery-led care ranked as the best use of resources, generating a net benefit of €1491.22 (95% CI 989.35-1991.93), compared with €123.23 (95% CI -376.58 to 621.42) for consultant-led care. CONCLUSIONS While both models of care are cost-beneficial, the decision to provide both alternatives may be constrained by resource issues. If only one alternative can be implemented then midwifery-led care should be undertaken for low-risk women, leaving consultant-led care for high-risk women. However, pursuing one alternative contradicts a key objective of government policy, which seeks to improve maternal choice. Ideally, multiple alternatives should be pursued.
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Affiliation(s)
- Christopher G Fawsitt
- Health Economics at Bristol (HEB), Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland.
| | - Jane Bourke
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Brendan McElroy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Jennifer E Lutomski
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosemary Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
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Value in Single-level Lumbar Discectomy: Surgical Disposable Item Cost and Relationship to Patient-reported Outcomes. Clin Spine Surg 2017; 30:E1227-E1232. [PMID: 28125437 DOI: 10.1097/bsd.0000000000000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVE Compare improvements in health status measures (HSMs) and surgical costs to determine whether use of more costly items has any relationship to clinical outcome and value in lumbar disc surgery. SUMMARY OF BACKGROUND DATA Association between cost, outcomes, and value in spine surgery, including lumbar discectomy is poorly understood. Outcomes were calculated as difference in mean HSM scores between preoperative and postoperative timeframes. Prospective validated patient-reported HSMs studied were EuroQol quality of life index score (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire (PHQ-9). Surgical costs consisted of disposable items and implants used in operating room. METHODS We retrospectively identified all adult patients at Cleveland Clinic main campus between October 2009 and August 2013 who underwent lumbar discectomy (652) using administrative billing data, Current Procedural Terminology (CPT) code 63030. HSMs were obtained from Cleveland Clinic Knowledge Program Data Registry. RESULTS In total, 67% of operations performed in the outpatient or ambulatory setting, 33% in the inpatient setting. Among 9 surgeons who performed >10 lumbar discectomies, there were 72.4 operations per surgeon, on average. Mean surgical costs of each surgeon differed (P<0.0001). In a multivariable regression, only the surgeon and surgery type (outpatient or inpatient) were statistically correlated with surgical costs (P<0.0001 and 0.046, respectively). Changes in EQ-5D, PDQ, and PHQ-9 were not correlated with surgical costs (P=0.76, 0.07, 0.76, respectively). In multivariable regression, only surgical cost was significantly correlated to mean difference in PDQ (P=0.030). More costly surgeries resulted in worse PDQ outcomes. CONCLUSIONS Mean surgical costs varied statistically among 9 surgeons; costs were not shown to be positively correlated with patient outcomes. Performing an operation using more costly disposable supplies/implants does not seem to improve patient outcomes and should be considered when constructing preference cards and during an operation.
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Tai BWB, Bae YH, Le QA. A Systematic Review of Health Economic Evaluation Studies Using the Patient's Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:903-908. [PMID: 27712720 DOI: 10.1016/j.jval.2016.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 05/01/2016] [Accepted: 05/18/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Patient-centered care has become increasingly important and relevant for informed health care decision making. OBJECTIVE Our study aimed to perform a systematic review of health economic evaluation studies from the patient's perspective. METHODS PubMed, EMBASE, and Cochrane Central databases were searched through May 2014 for cost-effectiveness, cost-utility, and cost-benefit studies using the patient's perspective in their analysis. The reporting quality of the studies was evaluated on the basis of Consolidated Health Economic Evaluation Reporting Standards. RESULTS We identified 30 health economic evaluations using the patient's perspective, of which 7 were conducted in the United States, 9 in Europe, and 14 in Asian or other countries. Seventeen of 23 health conditions evaluated were chronic in nature. Among 12 studies that justified the use of the patient's perspective, patient's financial burden associated with medical treatment was the most commonly cited rationale. A total of 29, 17, and 15 studies examined direct medical, direct nonmedical, and indirect costs, respectively. Seventeen studies also included societal, governmental or payer's, and/or provider's perspective(s) in their analyses. Based on Consolidated Health Economic Evaluation Reporting Standards, more than 20% of the reporting items in these studies were either partially satisfied or not satisfied. CONCLUSIONS There is a paucity of health economic evaluations conducted from the patient's perspective in the literature. For those studies using the patient's perspective, the true patient costs were not fully explored and study reporting quality was not optimal. With the increasing focus on patient-centered outcomes in health policy research, more frequent use of the patient's perspective in economic studies should be advocated.
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Affiliation(s)
| | - Yuna H Bae
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Quang A Le
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
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Wilkinson G, Drummond M. Alternative approaches for assessing the socioeconomic benefits of medical devices: a systematic review. Expert Rev Med Devices 2016; 12:629-48. [PMID: 26305841 DOI: 10.1586/17434440.2015.1080118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many medical devices offer improvements over current care that may be difficult to assess using standard methods of economic benefit measurement such as the quality-adjusted life-year (QALY). The objective of this research was to explore the extent to which these benefits have been measured and valued by alternative approaches, such as willingness-to-pay studies or discrete choice experiments. We undertook a systematic review of the literature from 1996 to 2013 to identify empirical studies on the benefits of medical devices using the alternative methodologies. The search resulted in 2772 hits, of which 2016 were considered not relevant to the study and 76 were duplicates. After further examination, there were 30 relevant empirical studies, of which 18 were willingness-to-pay and 12 discrete choice experiments. This research demonstrates that while it is feasible to measure and value the attributes of devices using alternative approaches to standard quality-of-life measures, the literature is quite limited when compared with that for non-device technologies.
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Sanghera S, Frew E, Gupta JK, Kai J, Roberts TE. Exploring the Use of Cost-Benefit Analysis to Compare Pharmaceutical Treatments for Menorrhagia. PHARMACOECONOMICS 2015; 33:957-965. [PMID: 25911537 PMCID: PMC4559088 DOI: 10.1007/s40273-015-0280-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The extra-welfarist theoretical framework tends to focus on health-related quality of life, whilst the welfarist framework captures a wider notion of well-being. EQ-5D and SF-6D are commonly used to value outcomes in chronic conditions with episodic symptoms, such as heavy menstrual bleeding (clinically termed menorrhagia). Because of their narrow-health focus and the condition's periodic nature these measures may be unsuitable. A viable alternative measure is willingness to pay (WTP) from the welfarist framework. OBJECTIVE We explore the use of WTP in a preliminary cost-benefit analysis comparing pharmaceutical treatments for menorrhagia. METHODS A cost-benefit analysis was carried out based on an outcome of WTP. The analysis is based in the UK primary care setting over a 24-month time period, with a partial societal perspective. Ninety-nine women completed a WTP exercise from the ex-ante (pre-treatment/condition) perspective. Maximum average WTP values were elicited for two pharmaceutical treatments, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral treatment. Cost data were offset against WTP and the net present value derived for treatment. Qualitative information explaining the WTP values was also collected. RESULTS Oral treatment was indicated to be the most cost-beneficial intervention costing £107 less than LNG-IUS and generating £7 more benefits. The mean incremental net present value for oral treatment compared with LNG-IUS was £113. The use of the WTP approach was acceptable as very few protests and non-responses were observed. CONCLUSION The preliminary cost-benefit analysis results recommend oral treatment as the first-line treatment for menorrhagia. The WTP approach is a feasible alternative to the conventional EQ-5D/SF-6D approaches and offers advantages by capturing benefits beyond health, which is particularly relevant in menorrhagia.
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Affiliation(s)
- Sabina Sanghera
- />Health Economics Unit, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
- />Health Economics Research Group, Brunel University London, Uxbridge, UB8 3PH UK
| | - Emma Frew
- />Health Economics Unit, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Janesh Kumar Gupta
- />School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
| | - Joe Kai
- />Division of Primary Care and National Institute for Health Research, University of Nottingham, Nottingham, UK
| | - Tracy Elizabeth Roberts
- />Health Economics Unit, Public Health Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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Naunheim MR, Kozin ED, Sethi RK, Ota HG, Gray ST, Shrime MG. Cost-Benefit Analysis of an Otolaryngology Emergency Room Using a Contingent Valuation Approach. Otolaryngol Head Neck Surg 2015. [PMID: 26216886 DOI: 10.1177/0194599815596742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Dedicated otolaryngology emergency rooms (ERs) provide a unique mechanism of health care delivery. Relative costs and willingness to pay (WTP) for these services have not been studied. This study aims to provide a cost-benefit analysis of otolaryngology-specific ER care. STUDY DESIGN Cost-benefit analysis based on contingent valuation surveys. SETTING An otolaryngology-specific ER in a tertiary care academic medical center. SUBJECTS AND METHODS Adult English-speaking patients presenting to an otolaryngology ER were included. WTP questions were used to assess patient valuations of specialty emergency care. Sociodemographic data, income, and self-reported levels of distress were assessed. State-level and institution-specific historical cost data were merged with WTP data within a cost-benefit analysis framework. RESULTS The response rate was 75.6%, and 199 patients were included in the final analysis. Average WTP for otolaryngology ER services was $319 greater than for a general ER (95% CI: $261 to $377), with a median value of $200. The historical mean cost per visit at a general ER was $575, and mean cost at the specialty ER was $551 (95% CI: $529 to $574). Subtracting incremental cost from incremental WTP yielded a net benefit of $343. CONCLUSION Dedicated otolaryngology ER services are valued by patients for acute otolaryngologic problems and have a net benefit of $343 per patient visit. They appear to be a cost-beneficial method for addressing acute otolaryngologic conditions. This study has implications for ER-based otolaryngologic care and direct-to-specialist services.
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Affiliation(s)
- Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliot D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosh K Sethi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - H Gregory Ota
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
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ALTERATIONS OF VASCULAR PIGMENT EPITHELIUM DETACHMENTS ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION DURING UPLOAD WITH INTRAVITREAL RANIBIZUMAB. Retina 2013; 33:1843-9. [DOI: 10.1097/iae.0b013e318287d9be] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sanghera S, Frew E, Kai J, Gupta J, Elizabeth Roberts T. An assessment of economic measures used in menorrhagia: a systematic review. Soc Sci Med 2013; 98:149-53. [PMID: 24331893 DOI: 10.1016/j.socscimed.2013.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 08/19/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022]
Abstract
'Menorrhagia', or heavy menstrual bleeding, is a common problem affecting women. The principal driver for treatment is women's experience of its interference in their lives, so a measure of quality of life (QoL) is increasingly used as the primary outcome to assess treatment success. QoL measures need to accurately reflect women's concerns as these measures are often used to inform resource allocation decisions within the healthcare service. Healthcare decision-makers often advocate the use of generic measures so as to achieve consistency when making decisions. Generic measures, by definition, have a broad focus on QoL in contrast to disease-specific measures that focus on dimensions of health relevant to the condition. We report a systematic review of studies that have either used or assessed economic outcome measures in menorrhagia, and present criteria for assessing which measure is the most appropriate. Studies including women presenting with menorrhagia, and using or assessing economic measures were sought by searching nine electronic databases. Fifty-six eligible studies were identified. A narrative synthesis was most suitable to the review question. Eleven studies assessed the psychometric properties of the outcome measures, twelve studies applied the measures in an economic evaluation, and thirty-three used them in effectiveness studies. Mixed results on the psychometric properties of the instruments were observed. Studies were often found to include both a disease-specific and a generic measure. We found no consensus on the most appropriate economic outcome measure to use when assessing the cost-effectiveness of treatment for menorrhagia. This is an important finding as QoL is the primary focus for treatment decisions. The cyclical nature of the condition has a large impact on the reliability and validity of outcome measurement. Alternative measures, such as willingness-to-pay, which embrace more than health and avoid standard recall periods should be explored.
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Affiliation(s)
- Sabina Sanghera
- Health Economics Unit, School of Health & Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
| | - Emma Frew
- Health Economics Unit, School of Health & Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joe Kai
- University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK
| | - Janesh Gupta
- Birmingham Women's Foundation NHS Trust, Edgbaston, Birmingham, B15 2TG, UK
| | - Tracy Elizabeth Roberts
- Health Economics Unit, School of Health & Population Sciences, Public Health Building, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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15
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Franic DM, Bothe AK, Bramlett RE. A welfare economic approach to measure outcomes in stuttering: comparing willingness to pay and quality adjusted life years. JOURNAL OF FLUENCY DISORDERS 2012; 37:300-313. [PMID: 23218213 DOI: 10.1016/j.jfludis.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/23/2012] [Accepted: 04/27/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE The purpose of this study was to compare two welfare outcome measures, willingness to pay (WTP) and quality adjusted life years (QALYs) gained, to measure outcomes in stuttering. METHOD Seventy-eight adult participants (74 nonstuttering and 4 persons with stuttering) completed one face-to-face structured interview regarding how much they would be willing to pay to alleviate severe stuttering in three interventions of varying impact. These data were compared with QALYs gained as calculated from time trade off (TTO) and standard gamble (SG) data. RESULTS Mean (median) WTP bids ranged from US $16,875 (8000), for an intervention resulting in improvement from severe stuttering to mild stuttering, to US $41,844 (10,000) for an intervention resulting in a cure of severe stuttering. These data were consistent with mean changes in QALYs for the same stuttering interventions ranging from 2.19 (using SG) to 18.42 (using TTO). CONCLUSIONS This study presents the first published WTP and QALY data for stuttering. Results were consistent with previous cost-of-illness data for stuttering. Both WTP and QALY measures were able to quantify the reduction in quality of life that occurs in stuttering, and both can be used to compare the gains that might be achieved by different interventions. It is widely believed that stuttering can cause reduced quality of life for some speakers; the introduction into this field of standardized metrics for measuring quality of life is a necessary step for transparently weighing the costs and consequences of stuttering interventions in economic analyses. EDUCATIONAL OBJECTIVES The reader will be able to (a) describe the underlying theoretical foundations for willingness to pay and quality adjusted life years, (b) describe the application of willingness to pay and quality adjusted life years for use in economic analyses, (c) compare and contrast the value of willingness to pay and quality adjusted life years in measuring the impact of stuttering treatment on quality of life, (d) interpret quality adjusted life years, and (e) interpret willingness to pay data.
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Affiliation(s)
- Duska M Franic
- Dept. of Clinical and Administrative Pharmacy, RC Wilson Building Room 260N, The University of Georgia, 250 W Green St, Athens, GA 30602-2354, USA.
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Pekkanen L, Neva M, Kautiainen H, Vihtonen K, Kyrölä K, Marttinen I, Wahlman M, Häkkinen A. Decreased disability is associated with improved perceived quality of life following spinal fusion. Disabil Rehabil 2012; 35:1364-70. [PMID: 23163718 DOI: 10.3109/09638288.2012.735339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess the disability and relationship between functional status and health related quality of life (HRQoL) in patients in the early recovery phase following spinal fusion. METHODS This is a prospective cohort study. Since 2008 data of spinal fusion patients have been collected prospectively in two Finnish hospitals. In August 2009, complete data of 173 patients were available. The measurement tool of disability was the Oswestry Disability Index (ODI) and it was also examined in the framework of International Classification of Functioning, Disability and Health (ICF) using body functions and structures, activities and participation components. RESULTS Preoperatively the mean total ODI was 45 (SD17) and mean (95% confidence interval) change to 3 months postoperatively was -19 (-22 to -17). When the ODI was linked to the ICF, there was a 55% improvement in the body structure and functions component and a 44% improvement in both the activities and the participation components. However, 25% of the patients still had the total ODI score over 40 three months postoperatively. Preoperatively, the mean (95% CI) Physical Component Summary Score (PCS) of the Short Form 36-questionnaire (SF-36) was 27 (26 to 28) and the mean Mental Component Summary Score (MCS) of SF-36 was 47 (45 to 49). Postoperatively the improvement was 9 (95% CI: 8 to 11) in PCS and 6 (95% CI: 4 to 7) in MCS (p < 0.001). CONCLUSIONS Spinal fusion is successful in the early recovery period in terms of reduction of pain and disability. The significant changes in the ODI were seen in all three components of the ICF model. In addition, improvement in functioning was significantly related to positive change in HRQoL. Still there is a subgroup of patients having marked disability needing more intensive rehabilitation and follow-ups.
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Affiliation(s)
- Liisa Pekkanen
- Department of Orthopaedics and Traumatology, Jyväskylä Central Hospital, Jyväskylä, Finland.
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Franic DM, Bothe AK, Bramlett RE. Assessment of respondent acceptability for preference measures in stuttering. JOURNAL OF COMMUNICATION DISORDERS 2012; 45:378-389. [PMID: 22682377 DOI: 10.1016/j.jcomdis.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 03/12/2012] [Accepted: 05/07/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To assess the feasibility of using one or more of four standard economic preference measures to assess health-related quality of life in stuttering, by assessing respondents' views of the acceptability of those measures. METHOD AND RESULTS A graphic positioning scale approach was used with 80 adults to assess four variables previously defined as reflecting the construct of respondent acceptability (difficulty of decision making, clarity of text, reasonableness for decision making, and comfort in decision making) for four types of preference measurement approaches (rating scale, standard gamble, time trade-off, and willingness to pay). A multivariate repeated measures analysis of variance (p<.001) and follow-up univariate repeated measures analyses of variance (all p<.01) were all significant, indicating that respondents perceived differences among the preference measurement methods on all four acceptability variables. CONCLUSION The rating scale was perceived as the easiest, clearest, most reasonable, and most comfortable tool, but it is not a measure of utility (an economic term for desirability or worth). If utility is the objective, such as for cost-utility analyses in stuttering, then the present results suggest the use of standard gamble (rather than time trade-off). These results also support the use of willingness to pay assessments for cost-benefit analyses in stuttering. These findings supplement results previously obtained for other chronic conditions. LEARNING OUTCOMES The reader will be able to: (1) describe how four standard economic preference measures [rating scale (RS), time trade-off (TTO), standard gamble (SG), and willingness to pay (WTP)] can be used in economic analyses; (2) describe how RS, TTO, SG and WTP can be measured; and (3) describe how respondents perceive the use of RS, TTO, SG and WTP in measuring changes in stuttering.
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Affiliation(s)
- Duska M Franic
- Dept. of Clinical and Administrative Pharmacy, RC Wilson Building Room 260N, University of Georgia, 250 W Green St, Athens, GA 30602, USA.
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Terashita T, Muto H, Nakamura T, Ogasawara K, Maezawa M. Willingness to pay for municipality hospital services in rural Japan: a contingent valuation study. BMC Res Notes 2011; 4:177. [PMID: 21645419 PMCID: PMC3130668 DOI: 10.1186/1756-0500-4-177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 06/07/2011] [Indexed: 11/10/2022] Open
Abstract
Background The Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP) for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews. Findings Forty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%). As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71), with a 95% confidence interval 27,806-55,437 yen ($308.95-615.96). Logistic regression revealed no significant factors affecting WTP. Conclusions If the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844). This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality hospital, which nearly equalled the amount that the K town government provided to the municipality hospital to cover its annual deficit. K town residents had come to expect not only general clinical practice, but also emergency medical services and night practice provided by their own town's municipality hospital. WTP can be used as a measure of hospital evaluation because it reflects the importance of the hospital to the residents in its region.
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Affiliation(s)
- Takayoshi Terashita
- Department of Healthcare Systems Research, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
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Boos N. The impact of economic evaluation on quality management in spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18 Suppl 3:338-47. [PMID: 19337760 DOI: 10.1007/s00586-009-0939-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 03/05/2009] [Indexed: 12/30/2022]
Abstract
Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.
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Affiliation(s)
- Norbert Boos
- Centre for Spinal Surgery, University of Zurich, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
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