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Sittimart M, Rattanavipapong W, Mirelman AJ, Hung TM, Dabak S, Downey LE, Jit M, Teerawattananon Y, Turner HC. An overview of the perspectives used in health economic evaluations. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:41. [PMID: 38741138 DOI: 10.1186/s12962-024-00552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024] Open
Abstract
The term 'perspective' in the context of economic evaluations and costing studies in healthcare refers to the viewpoint that an analyst has adopted to define the types of costs and outcomes to consider in their studies. However, there are currently notable variations in terms of methodological recommendations, definitions, and applications of different perspectives, depending on the objective or intended user of the study. This can make it a complex area for stakeholders when interpreting these studies. Consequently, there is a need for a comprehensive overview regarding the different types of perspectives employed in such analyses, along with the corresponding implications of their use. This is particularly important, in the context of low-and-middle-income countries (LMICs), where practical guidelines may be less well-established and infrastructure for conducting economic evaluations may be more limited. This article addresses this gap by summarising the main types of perspectives commonly found in the literature to a broad audience (namely the patient, payer, health care providers, healthcare sector, health system, and societal perspectives), providing their most established definitions and outlining the corresponding implications of their uses in health economic studies, with examples particularly from LMIC settings. We then discuss important considerations when selecting the perspective and present key arguments to consider when deciding whether the societal perspective should be used. We conclude that there is no one-size-fits-all answer to what perspective should be used and the perspective chosen will be influenced by the context, policymakers'/stakeholders' viewpoints, resource/data availability, and intended use of the analysis. Moving forward, considering the ongoing issues regarding the variation in terminology and practice in this area, we urge that more standardised definitions of the different perspectives and the boundaries between them are further developed to support future studies and guidelines, as well as to improve the interpretation and comparison of health economic evidence.
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Affiliation(s)
- Manit Sittimart
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | | | | | - Trinh Manh Hung
- Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Vietnam
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
| | - Laura E Downey
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore
| | - Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
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Vasantharoopan A, Simms V, Chan Y, Guinness L, Maheswaran H. Modelling Methods of Economic Evaluations of HIV Testing Strategies in Sub-Saharan Africa: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:585-601. [PMID: 36853553 DOI: 10.1007/s40258-022-00782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Economic evaluations, a decision-support tool for policy makers, will be crucial in planning and tailoring HIV prevention and treatment strategies especially in the wake of stalled and decreasing funding for the global HIV response. As HIV testing and treatment coverage increase, case identification becomes increasingly difficult and costly. Determining which subset of the population these strategies should be targeted to becomes of vital importance as well. Generating quality economic evidence begins with the validity of the modelling approach and the model structure employed. This study synthesises and critiques the reporting around modelling methodology of economic models in the evaluation of HIV testing strategies in sub-Saharan Africa. METHODS The following databases were searched from January 2000 to September 2020: MEDLINE, Embase, Scopus, EconLit and Global Health. Any model-based economic evaluation of a unique HIV testing strategy conducted in sub-Saharan Africa presenting a cost-effectiveness measure published from 2013 onwards was eligible. Data were extracted around three components: general study characteristics; economic evaluation design; and quality of model reporting using a novel tool developed for the purposes of this study. RESULTS A total of 21 studies were included; 10 cost-effectiveness analyses, 11 cost-utility analyses. All but one study was conducted in Eastern and Southern Africa. Modelling approaches for HIV testing strategies can be broadly characterised as static aggregate models (3/21), static individual models (6/21), dynamic aggregate models (5/21) and dynamic individual models (7/21). Adequate reporting around data handling was the highest of the three categories assessed (74%), and model validation, the lowest (45%). Limitations to model structure, justification of chosen time horizon and cycle length, and description of external model validation process were all adequately reported in less than 40% of studies. The predominant limitation of this review relates to the potential implications of the narrow inclusion criteria. CONCLUSIONS This review is the first to synthesise economic evaluations of HIV testing strategies in sub-Saharan Africa. The majority of models exhibited dynamic, stochastic and individual properties. Model reporting against the 13 criteria in our novel tool was mixed. Future model-based economic evaluations of HIV testing strategies would benefit from transparency around the choice of modelling approach, model structure, data handling procedures and model validation techniques.
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Affiliation(s)
- Arthi Vasantharoopan
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Yuyen Chan
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Lorna Guinness
- London School of Hygiene and Tropical Medicine, London, UK
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Turner HC, Sandmann FG, Downey LE, Orangi S, Teerawattananon Y, Vassall A, Jit M. What are economic costs and when should they be used in health economic studies? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:31. [PMID: 37189118 DOI: 10.1186/s12962-023-00436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/18/2023] [Indexed: 05/17/2023] Open
Abstract
Economic analyses of healthcare interventions are an important consideration in evidence-based policymaking. A key component of such analyses is the costs of interventions, for which most are familiar with using budgets and expenditures. However, economic theory states that the true value of a good/service is the value of the next best alternative forgone as a result of using the resource and therefore observed prices or charges do not necessarily reflect the true economic value of resources. To address this, economic costs are a fundamental concept within (health) economics. Crucially, they are intended to reflect the resources' opportunity costs (the forgone opportunity to use those resources for another purpose) and they are based on the value of the resource's next-best alternative use that has been forgone. This is a broader conceptualization of a resource's value than its financial cost and recognizes that resources can have a value that may not be fully captured by their market price and that by using a resource it makes it unavailable for productive use elsewhere. Importantly, economic costs are preferred over financial costs for any health economic analyses aimed at informing decisions regarding the optimum allocation of the limited/competing resources available for healthcare (such as health economic evaluations), and they are also important when considering the replicability and sustainability of healthcare interventions. However, despite this, economic costs and the reasons why they are used is an area that can be misunderstood by professionals without an economic background. In this paper, we outline to a broader audience the principles behind economic costs and when and why they should be used within health economic analyses. We highlight that the difference between financial and economic costs and what adjustments are needed within cost calculations will be influenced by the context of the study, the perspective, and the objective.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
| | - Frank G Sandmann
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Laura E Downey
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Stacey Orangi
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
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Behzadifar M, Behzadifar M, Saran M, Shahabi S, Bakhtiari A, Azari S, Bragazzi NL. The role of Iran's context for the development of health technology assessment: challenges and solutions. HEALTH ECONOMICS REVIEW 2023; 13:23. [PMID: 37079131 PMCID: PMC10116738 DOI: 10.1186/s13561-023-00438-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
Health technology assessment (HTA) is a comprehensive and structured evaluation that aims to analyze the potential impacts of health technologies, including medical devices, diagnostic tools, pharmaceuticals, and public health interventions. Its purpose is to provide policymakers with evidence-based information to inform decisions related to the utilization and implementation of these technologies. HTA allows for the comparison of various scenarios related to a technology across a wide range of factors. This can aid in the creation of an essential drug list and health benefits package that is tailored to the actual needs of the community within a given healthcare system. In the present paper, we review the role of Iran's context for the development of HTA, in terms of challenges and solutions.
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Affiliation(s)
- Meysam Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Saran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahad Bakhtiari
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Samad Azari
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Nicola Luigi Bragazzi
- Human Nutrition Unit Department of Food and Drugs, University of Parma Medical School, Building C, Via Volturno, 39, 43125 Parma, Italy
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Hannah LA, Walsh CM, Jopling L, Perez J, Cardinal RN, Cameron RA. Economic evaluation of interventions for treatment-resistant depression: A systematic review. Front Psychiatry 2023; 14:1056210. [PMID: 36873195 PMCID: PMC9979220 DOI: 10.3389/fpsyt.2023.1056210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background The extraordinarily high prevalence of treatment-resistant depression (TRD), coupled with its high economic burden to both healthcare systems and society, underscore how critical it is that resources are managed optimally to address the significant challenge it presents. Objective To review the literature on economic evaluation in TRD systematically, with the aim of informing future studies by identifying key challenges specific to the area, and highlighting good practices. Methods A systematic literature search across seven electronic databases was conducted to identify both within-trial and model-based economic evaluations in TRD. Quality of reporting and study design was assessed using the Consensus Health Economic Criteria (CHEC). A narrative synthesis was conducted. Results We identified 31 evaluations, including 11 conducted alongside a clinical trial and 20 model-based evaluations. There was considerable heterogeneity in the definition of treatment-resistant depression, although with a trend for more recent studies to use a definition of inadequate response to two or more antidepressive treatments. A broad range of interventions were considered, including non-pharmacological neuromodulation, pharmacological, psychological, and service-level interventions. Study quality as assessed by CHEC was generally high. Frequently poorly reported items related to discussion of ethical and distributional issues, and model validation. Most evaluations considered comparable core clinical outcomes - encompassing remission, response, and relapse. There was good agreement on the definitions and thresholds for these outcomes, and a relatively small pool of outcome measures were used. Resource criteria used to inform the estimation of direct costs, were reasonably uniform. Predominantly, however, there was a high level of heterogeneity in terms of evaluation design and sophistication, quality of evidence used (particularly health state utility data), time horizon, population considered, and cost perspective. Conclusion Economic evidence for interventions in TRD is underdeveloped, particularly so for service-level interventions. Where evidence does exist, it is hampered by inconsistency in study design, methodological quality, and availability of high quality long-term outcomes evidence. This review identifies a number of key considerations and challenges for the design of future economic evaluations. Recommendations for research and suggestions for good practice are made. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259848&VersionID=1542096, identifier CRD42021259848.
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Affiliation(s)
- Laura A. Hannah
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Cathy M. Walsh
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Louise Jopling
- Eastern Academic Health Science Network, Cambridge, United Kingdom
| | - Jesus Perez
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
- Psychiatry Unit, Department of Medicine, Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
| | - Rudolf N. Cardinal
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Rory A. Cameron
- Applied Research Collaboration East of England, National Institute for Health and Care Research, Cambridge, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Avşar TS, Yang X, Lorgelly P. How is the Societal Perspective Defined in Health Technology Assessment? Guidelines from Around the Globe. PHARMACOECONOMICS 2023; 41:123-138. [PMID: 36471131 DOI: 10.1007/s40273-022-01221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 06/17/2023]
Abstract
Some researchers have argued that the aim of an economic evaluation should be to offer guidance on resource allocation based on public interest from a societal perspective. The application of a societal perspective in health technology assessment (HTA), while common in many published studies, is not mandated in most countries, and there is limited discussion on what the societal perspective should encompass. This study aimed to systematically compare and contrast the HTA guidelines in different countries. HTA methods guidelines were identified through international HTA networks, such as the Professional Society for Health Economics and Outcomes Research (ISPOR) and Guide to Economic Analysis Research (GEAR). The respective HTA agencies were grouped into two categories: well-established and newly developed, based on the establishment date. Data extracted from the guidelines summarised the methodological details in the reference cases, including specifics on the societal perspective. The database search yielded 46 guidelines, and 65% explicitly considered the societal perspective. The maturity of these agencies is reflected in their attitudes towards the societal perspective; the societal perspective is defined in 73% of the guidelines of well-established agencies and only 56% of those of newly developed agencies. The guidelines from multipayer healthcare systems are more likely to consider the societal perspective. Although most guidelines from the well-established agencies recommend the inclusion of a societal perspective, the types of costs and consequences that should be included and the recommended approaches to valuing them are variable. The direct costs to family and carers were included in 73% of the societal perspective definitions, while non-health outcomes were considered in only 40%. Most HTA guidelines lack clear guidance on what to include under specific perspectives. Considering the recent advancements in economic evaluation methods, it is timely to rethink the role of the societal perspective in HTA guidelines and adopt a more comprehensive perspective to include all costs and consequences of healthcare services.
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Affiliation(s)
- Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, UK.
| | - Xiaozhe Yang
- Institute of Global Health, University College London, London, UK
| | - Paula Lorgelly
- School of Population Health and Department of Economics, University of Auckland, Auckland, New Zealand
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See-Toh RSE, Wong XY, Mahboobani KSKH, Soon SS, Kearns B, Cooper K, Ho KW, Kuntjoro I, Ng K. Cost-effectiveness of transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis of intermediate surgical risk in Singapore. BMC Health Serv Res 2022; 22:994. [PMID: 35927703 PMCID: PMC9354430 DOI: 10.1186/s12913-022-08369-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective The objective was to assess the cost-effectiveness of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis with intermediate surgical risk in Singapore. Methods A de novo Markov model with three health states – stroke with long-term sequelae, no stroke, and death – was developed and simulated using Monte Carlo simulations with 10,000 iterations over a five-year time horizon from the Singapore healthcare system perspective. A 3% annual discount rate for costs and outcomes and monthly cycle lengths were used. By applying the longest available published clinical evidence, simulated patients received either TAVI or surgical aortic valve replacement (SAVR) and were at risk of adverse events (AEs) such as moderate-to-severe paravalvular aortic regurgitation (PAR). Results When five-year PARTNER 2A data was applied, base-case analyses showed that the incremental cost-effectiveness ratio (ICER) for TAVI compared to SAVR was US$315,760 per quality-adjusted life year (QALY) gained. The high ICER was due to high incremental implantation and procedure costs of TAVI compared to SAVR, and marginal improvement of 0.10 QALYs as simulated mortality of TAVI exceeded SAVR at 3.75 years post-implantation. One-way sensitivity analysis showed that the ICERs were most sensitive to cost of PAR, utility values of SAVR patients, and cost of TAVI and SAVR implants and procedures. When disutilities for AEs were additionally applied, the ICER decreased to US$300,070 per QALY gained. TAVI was dominated by SAVR when the time horizon increased to 20 years. Clinical outcomes projected from one-year PARTNER S3i data further reduced the ICER to US$86,337 per QALY gained for TAVI, assuming early all-cause mortality benefits from TAVI continued to persist. This assumption was undermined when longer term data showed that TAVI’s early mortality benefits diminished at five years. Limitations and conclusion TAVI is unlikely to be cost-effective in intermediate surgical-risk patients compared to SAVR in Singapore. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08369-5.
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Affiliation(s)
| | - Xin Yi Wong
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore
| | | | - Swee Sung Soon
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore
| | - Benjamin Kearns
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore, Singapore.
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Culyer AJ, Chalkidou K. Organising Research and Development for evidence-informed health care: some universal characteristics and a case study from the UK. HEALTH ECONOMICS, POLICY, AND LAW 2021; 16:489-504. [PMID: 33843559 PMCID: PMC8460448 DOI: 10.1017/s1744133121000074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/13/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Abstract
Research and Development (R&D) in health and health care has several intriguing characteristics which, separately and in combination, have significant implications for the ways in which it is organised, funded and managed. We review the characteristics, some of which apply under most circumstances and others of which may be context-specific, explore their implications for the organisation and management of health-related R&D, and illustrate the main features from the UK experience in the 1990s.
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Affiliation(s)
- Anthony J. Culyer
- University of York – Centre for Health Economics, York, United Kingdom of Great Britain and Northern Ireland
| | - Kalipso Chalkidou
- University of York – Centre for Health Economics, York, United Kingdom of Great Britain and Northern Ireland
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Kim DD, Silver MC, Kunst N, Cohen JT, Ollendorf DA, Neumann PJ. Perspective and Costing in Cost-Effectiveness Analysis, 1974-2018. PHARMACOECONOMICS 2020; 38:1135-1145. [PMID: 32696192 PMCID: PMC7373843 DOI: 10.1007/s40273-020-00942-2] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs). METHODS We analyzed the Tufts Medical Center's CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives. RESULTS Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900-110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67-3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017-2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991-49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486-77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective. CONCLUSION Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA.
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Madison C Silver
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
| | - Natalia Kunst
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- LINK Medical Research, Oslo, Norway
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Stepovic M, Rancic N, Vekic B, Dragojevic-Simic V, Vekic S, Ratkovic N, Jakovljevic M. Gross Domestic Product and Health Expenditure Growth in Balkan and East European Countries-Three-Decade Horizon. Front Public Health 2020; 8:492. [PMID: 33042939 PMCID: PMC7522281 DOI: 10.3389/fpubh.2020.00492] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 07/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Dynamics of health care has changed over time along with development of the countries themselves. The aim of the study is to compare macroeconomic and health expenditure indicators of interest, such as total health expenditure (THE) as percentage of global domestic product, global domestic product per capita in US$, and private households' out-of-pocket payments of Balkan and Eastern European countries on health, as well as to assess their progress over the observed period. Methods: This research report represents a descriptive data analysis of indicators extracted from the European Health for All database. The data were analyzed using a linear trend and regression analysis to estimate the timeline changes. Results: Greece and Slovenia have the largest median values of global domestic product per capita throughout the whole period, and the largest increment trend was in Lithuania. Median value in out-of-pocket payment of THE was the highest in Albania and Ukraine, while the largest decrease in trend was noticed in Albania and Bosnia and Herzegovina. Bosnia and Herzegovina and Greece had the largest median value of THE as percentage of Gross Domestic Product (GDP) in the observed period, while regression trend analysis showed that Serbia had the largest increase. Most of the countries showed a significant correlation between observed indicators. Conclusion: Trends in the economy must be constantly monitored due to the fact that the population is aging and non-communicable diseases are multiplying, which requires innovations in medical treatment and pharmaceutical development.
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Affiliation(s)
- Milos Stepovic
- Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Berislav Vekic
- Clinic for Surgery, University Hospital Center “Dr. Dragisa Misovic”, Belgrade, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Viktorija Dragojevic-Simic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Stefan Vekic
- Faculty of Economics, University of Belgrade, Belgrade, Serbia
| | - Nenad Ratkovic
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
- Treatment Sector, Military Medical Academy, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- The N.A.Semashko Public Health and Healthcare Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Charlton V, Rid A. Innovation as a value in healthcare priority-setting: the UK experience. SOCIAL JUSTICE RESEARCH 2019; 32:208-238. [PMID: 31281204 PMCID: PMC6581918 DOI: 10.1007/s11211-019-00333-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
All healthcare systems operate with limited resources and therefore need to set priorities for allocating resources across a population. Trade-offs between maximising health and promoting health equity are inevitable in this process. In this paper, we use the UK's National Institute for Health and Care Excellence (NICE) as an example to examine how efforts to promote healthcare innovation in the priority-setting process can complicate these trade-offs. Drawing on NICE guidance, health technology assessment reports and relevant policy documents, we analyse under what conditions NICE recommends the National Health Service fund technologies of an "innovative nature", even when these technologies do not satisfy NICE's cost-effectiveness criteria. Our findings fail to assuage pre-existing concerns that NICE's approach to appraising innovative technologies curtails its goals to promote health and health equity. They also reveal a lack of transparency and accountability regarding NICE's treatment of innovative technologies, as well as raising additional concerns about equity. We conclude that further research needs to evaluate how NICE can promote health and health equity alongside healthcare innovation and draw some general lessons for healthcare priority-setting bodies like NICE.
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Affiliation(s)
- Victoria Charlton
- Department of Global Health & Social Medicine, King’s College London, 40 Aldwych, London, WC2B 4BG UK
| | - Annette Rid
- Department of Global Health & Social Medicine, King’s College London, 40 Aldwych, London, WC2B 4BG UK
- Department of Bioethics, The Clinical Center, U.S. National Institutes of Health, Bethesda, USA
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Campillo-Artero C, Puig-Junoy J, Culyer AJ. Authors' Reply to Angelis and Kanavos: "Does MCDA Trump CEA?". APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:125. [PMID: 30460622 DOI: 10.1007/s40258-018-0446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Carlos Campillo-Artero
- Center for Research in Health and Economics, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain
| | - Jaume Puig-Junoy
- Center for Research in Health and Economics, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain.
- Department of Economics and Business, Pompeu Fabra University, Ramon Trias Fargas 25-27, 08005, Barcelona, Spain.
| | - Anthony J Culyer
- Department of Economics and Related Studies and Center for Health Economics, University of York, York, YO10 5DD, UK
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Isaranuwatchai W, Li R, Glassman A, Teerawattananon Y, Culye AJ, Chalkidou K. Disease Control Priorities Third Edition: Time to Put a Theory of Change Into Practice Comment on "Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy". Int J Health Policy Manag 2019; 8:132-135. [PMID: 30980627 PMCID: PMC6462203 DOI: 10.15171/ijhpm.2018.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023] Open
Abstract
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, ON, Canada
| | - Ryan Li
- School of Public Health, Imperial College London, London, UK
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Anthony J Culye
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, UK
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, UK.,Center for Global Development, London, UK
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