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Gheorghe A, Mehndiratta A, Baker P, Culyer A, Prinja S, Kar SS, Guzman J. Health technology assessment in India in the next decade: reflections on a vision for its path to maturity and impact. BMJ Evid Based Med 2024:bmjebm-2023-112491. [PMID: 38290800 DOI: 10.1136/bmjebm-2023-112491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Adrian Gheorghe
- Center for Global Development, Washington, District of Columbia, USA
- Imperial College London, London, UK
| | - Abha Mehndiratta
- Center for Global Development, Washington, District of Columbia, USA
| | - Peter Baker
- Center for Global Development, Washington, District of Columbia, USA
| | | | | | | | - Javier Guzman
- Center for Global Development, Washington, District of Columbia, USA
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2
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Charlton V, DiStefano M, Mitchell P, Morrell L, Rand L, Badano G, Baker R, Calnan M, Chalkidou K, Culyer A, Howdon D, Hughes D, Lomas J, Max C, McCabe C, O'Mahony JF, Paulden M, Pemberton-Whiteley Z, Rid A, Scuffham P, Sculpher M, Shah K, Weale A, Wester G. We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment. Health Econ Policy Law 2023:1-21. [PMID: 37752732 DOI: 10.1017/s1744133123000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper - developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting - seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.
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Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Michael DiStefano
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
| | - Polly Mitchell
- School of Education, Communication and Society, King's College London, London, UK
| | - Liz Morrell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Leah Rand
- Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | | | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Michael Calnan
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | | | - Anthony Culyer
- Centre for Health Economics, University of York, York, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | | | - Christopher McCabe
- Centre for Public Health and Queens Management School, Queens University Belfast, Belfast, UK
| | - James F O'Mahony
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Annette Rid
- Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Paul Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Koonal Shah
- Science Policy and Research Programme, National Institute for Health and Care Excellence, London, UK
| | - Albert Weale
- School of Public Policy, University College London, London, UK
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Oortwijn W, Husereau D, Abelson J, Barasa E, Bayani DD, Canuto Santos V, Culyer A, Facey K, Grainger D, Kieslich K, Ollendorf D, Pichon-Riviere A, Sandman L, Strammiello V, Teerawattananon Y. Designing and Implementing Deliberative Processes for Health Technology Assessment: A Good Practices Report of a Joint HTAi/ISPOR Task Force. Value Health 2022; 25:869-886. [PMID: 35667778 PMCID: PMC7613534 DOI: 10.1016/j.jval.2022.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Deliberative processes for health technology assessment (HTA) are intended to facilitate participatory decision making, using discussion and open dialogue between stakeholders. Increasing attention is being given to deliberative processes, but guidance is lacking for those who wish to design or use them. Health Technology Assessment International (HTAi) and ISPOR-The Professional Society for Health Economics and Outcomes Research initiated a joint Task Force to address this gap. METHODS The joint Task Force consisted of 15 members with different backgrounds, perspectives, and expertise relevant to the field. It developed guidance and a checklist for deliberative processes for HTA. The guidance builds upon the few, existing initiatives in the field, as well as input from the HTA community following an established consultation plan. In addition, the guidance was subject to 2 rounds of peer review. RESULTS A deliberative process for HTA consists of procedures, activities, and events that support the informed and critical examination of an issue and the weighing of arguments and evidence to guide a subsequent decision. Guidance and an accompanying checklist are provided for (i) developing the governance and structure of an HTA program and (ii) informing how the various stages of an HTA process might be managed using deliberation. CONCLUSIONS The guidance and the checklist contain a series of questions, grouped by 6 phases of a model deliberative process. They are offered as practical tools for those wishing to establish or improve deliberative processes for HTA that are fit for local contexts. The tools can also be used for independent scrutiny of deliberative processes.
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Affiliation(s)
- Wija Oortwijn
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Diana Dana Bayani
- Health Intervention and Policy Evaluation Research (HIPER), Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vania Canuto Santos
- Department of Management and Incorporation of Health Technology, Executive Secretariat of National Committee Health Technology Incorporation (CONITEC), Ministry of Health, Brasilia, Brazil
| | - Anthony Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - Karen Facey
- Evidence Based Health Policy Consultant, Drymen, Scotland
| | | | - Katharina Kieslich
- Department of Political Science, Centre for the Study of Contemporary Solidarity, University of Vienna, Vienna, Austria
| | - Daniel Ollendorf
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts University Medical Centre, Boston, MA, USA
| | - Andrés Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), University of Buenos Aires, Buenos Aires, Argentina
| | - Lars Sandman
- National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Programme (HITAP), Ministry of Health, Bangkok, Thailand
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4
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Downey L, Dabak S, Eames J, Teerawattananon Y, De Francesco M, Prinja S, Guinness L, Bhargava B, Rajsekar K, Asaria M, Rao N, Selvaraju V, Mehndiratta A, Culyer A, Chalkidou K, Cluzeau F. Building Capacity for Evidence-Informed Priority Setting in the Indian Health System: An International Collaborative Experience. Health Policy Open 2020; 1:100004. [PMID: 33392500 PMCID: PMC7772949 DOI: 10.1016/j.hpopen.2020.100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/09/2019] [Accepted: 02/17/2020] [Indexed: 11/16/2022] Open
Abstract
India's rapid economic growth has been accompanied by slower improvements in population health. Given the need to reconcile the ambitious goal of achieving Universal Coverage with limited resources, a robust priority-setting mechanism is required to ensure that the right trade-offs are made and the impact on health is maximised. Health Technology Assessment (HTA) is endorsed by the World Health Assembly as the gold standard approach to synthesizing evidence systematically for evidence-informed priority setting (EIPS). India is formally committed to institutionalising HTA as an integral component of the EIPS process. The effective conduct and uptake of HTA depends on a well-functioning ecosystem of stakeholders adept at commissioning and generating policy-relevant HTA research, developing and utilising rigorous technical, transparent, and inclusive methods and processes, and a strong multisectoral and transnational appetite for the use of evidence to inform policy. These all require myriad complex and complementary capacities to be built at each level of the health system . In this paper we describe how a framework for targeted and locally-tailored capacity building for EIPS, and specifically HTA, was collaboratively developed and implemented by an international network of priority-setting expertise, and the Government of India.
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Affiliation(s)
- L.E. Downey
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Corresponding author at: Imperial College London, St Mary’s Hospital, Praed Street, London W2 1NY, United Kingdom.
| | - S. Dabak
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - J. Eames
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - Y. Teerawattananon
- Health Intervention Technology Assessment Program (HITAP), Bangkok, Thailand
| | - M. De Francesco
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - S. Prinja
- School of Public Health, Post Graduate Medical Institute of Health Education and Research (PGIMER) Chandigarh, India
| | - L. Guinness
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - B. Bhargava
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - K. Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - M. Asaria
- London School of Economics and Political Science, London, United Kingdom
| | - N.V. Rao
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - V. Selvaraju
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Mehndiratta
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
| | - A. Culyer
- Centre for Health Economics, University of York, York, United Kingdom
| | - K. Chalkidou
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Global Development Europe, London, United Kingdom
| | - F.A. Cluzeau
- Global Health and Development, School of Public Health, Imperial College London, London, United Kingdom
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Chi YL, Blecher M, Chalkidou K, Culyer A, Claxton K, Edoka I, Glassman A, Kreif N, Jones I, Mirelman AJ, Nadjib M, Morton A, Norheim OF, Ochalek J, Prinja S, Ruiz F, Teerawattananon Y, Vassall A, Winch A. What next after GDP-based cost-effectiveness thresholds? Gates Open Res 2020; 4:176. [PMID: 33575544 PMCID: PMC7851575 DOI: 10.12688/gatesopenres.13201.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/30/2022] Open
Abstract
Public payers around the world are increasingly using cost-effectiveness thresholds (CETs) to assess the value-for-money of an intervention and make coverage decisions. However, there is still much confusion about the meaning and uses of the CET, how it should be calculated, and what constitutes an adequate evidence base for its formulation. One widely referenced and used threshold in the last decade has been the 1-3 GDP per capita, which is often attributed to the Commission on Macroeconomics and WHO guidelines on Choosing Interventions that are Cost Effective (WHO-CHOICE). For many reasons, however, this threshold has been widely criticised; which has led experts across the world, including the WHO, to discourage its use. This has left a vacuum for policy-makers and technical staff at a time when countries are wanting to move towards Universal Health Coverage
. This article seeks to address this gap by offering five practical options for decision-makers in low- and middle-income countries that can be used instead of the 1-3 GDP rule, to combine existing evidence with fair decision-rules or develop locally relevant CETs. It builds on existing literature as well as an engagement with a group of experts and decision-makers working in low, middle and high income countries.
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Affiliation(s)
- Y-Ling Chi
- Center for Global Development, London, SW1P 3SE, UK
| | | | - Kalipso Chalkidou
- Center for Global Development, London, SW1P 3SE, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, SW7 2AZ, UK
| | - Anthony Culyer
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Karl Claxton
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Ijeoma Edoka
- School of Public Health, Wits University, Parktown, 2193, South Africa
| | | | - Noemi Kreif
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Iain Jones
- Sightsavers, Haywards Health, RH16 3BW, UK
| | - Andrew J Mirelman
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Mardiati Nadjib
- Faculty of Public Health, Department of Health Policy and Administration, Universitas Indonesia, Depok, Indonesia
| | | | - Ole Frithjof Norheim
- BCEPS, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jessica Ochalek
- Centre for Health Economics, Department of Economics and Related Studies, University of York, York, YO10 5DD, UK
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Francis Ruiz
- Center for Global Development, London, SW1P 3SE, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, SW7 2AZ, UK
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Thailand, Nonthaburi, 11000, Thailand
| | - Anna Vassall
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Alexander Winch
- Department of Infectious Disease Epidemiology, Imperial College London, London, SW7 2AZ, UK
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Teerawattananon Y, Luz AC, Culyer A, Chalkidou K. Charging for the use of survey instruments on population health: the case of quality-adjusted life years. Bull World Health Organ 2020; 98:59-65. [PMID: 31902963 PMCID: PMC6933437 DOI: 10.2471/blt.19.233239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/10/2019] [Accepted: 09/27/2019] [Indexed: 11/27/2022] Open
Abstract
A trend towards charging for access to research findings, tools and databases is becoming more prominent globally. But charging for the use of research tools and databases that are vital to research supporting national and international policy development might be unjustified. Financial barriers to accessing these tools and databases disproportionately affect low- and middle-income countries, who may have greater need for information that fuels research in their areas of concern. However, changing this trend is potentially possible. One example is the experience with the EuroQol-five-dimensional questionnaire (EQ-5D), a generic measure of health status used in economic evaluations for resource allocation decisions. Increasingly, governments and health-care providers are using the EQ-5D tool in patient-reported outcome measures to monitor quality of health-care provision, diagnose and track disease progression, and involve patients in their health care. The EuroQol Group, which owns the intellectual property rights to the EQ-5D, recently terminated their policy of charging for noncommercial, nonresearch uses of the tool. We share a brief history of this development and examine these charging policies in the context of the EQ-5D’s use in national health-care research and policies, reflecting the trends and developments in the use of survey instruments on population health.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), 6th floor, 6th building, Department of Health, Ministry of Public Health, Tiwanon Rd, Taladkhwan, Mueang Nonthaburi, Nonthaburi 11000, Thailand
| | - Alia Cg Luz
- Health Intervention and Technology Assessment Program (HITAP), 6th floor, 6th building, Department of Health, Ministry of Public Health, Tiwanon Rd, Taladkhwan, Mueang Nonthaburi, Nonthaburi 11000, Thailand
| | - Anthony Culyer
- University of York, Centre for Health Economics, York, England
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, England
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Gheorghe A, Chalkidou K, Culyer A. How concentrated are academic publications of countries' progression towards universal health coverage? Lancet Glob Health 2019; 7:e696-e697. [PMID: 31097270 DOI: 10.1016/s2214-109x(19)30154-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Adrian Gheorghe
- Global Health and Development Group and Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London SW7 2AZ, UK.
| | - Kalipso Chalkidou
- Global Health and Development Group and Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London SW7 2AZ, UK
| | - Anthony Culyer
- Department of Economics and Related Studies, University of York, York, UK
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8
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Hauck K, Morton A, Chalkidou K, Chi YL, Culyer A, Levin C, Meacock R, Over M, Thomas R, Vassall A, Verguet S, Smith PC. How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations. Soc Sci Med 2019; 220:141-149. [PMID: 30428401 PMCID: PMC6323413 DOI: 10.1016/j.socscimed.2018.10.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 11/23/2022]
Abstract
Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.
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Affiliation(s)
- K Hauck
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom.
| | - A Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, 199 Cathedral Street, Glasgow, G4 0QU, United Kingdom.
| | - K Chalkidou
- Center for Global Development, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom.
| | - Y-Ling Chi
- Global Health and Development Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Medical School Building, St Mary's Campus, London, W2 1PG, United Kingdom.
| | - A Culyer
- Department of Economics and Related Studies, University of York, Heslington, York, YO10 5DD, United Kingdom.
| | - C Levin
- Department of Global Health, University of Washington, NJB Box #359931, 325 Ninths Avenue, Seattle, WA, 98104, USA.
| | - R Meacock
- Centre for Primary Care, The University of Manchester, 4.311 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - M Over
- Center for Global Development, 2055 L Street NW, Fifth Floor, Washington, DC, 20036, USA.
| | - R Thomas
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - A Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom.
| | - S Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - P C Smith
- Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom.
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9
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Culyer A, Chalkidou K, Teerawattananon Y, Santatiwongchai B. Rival perspectives in health technology assessment and other economic evaluations for investing in global and national health. Who decides? Who pays? F1000Res 2018; 7:72. [PMID: 29904588 PMCID: PMC5961761 DOI: 10.12688/f1000research.13284.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/20/2022] Open
Abstract
There seems to be a general agreement amongst practitioners of economic evaluations, including Health Technology Assessment, that the explicit statement of a perspective is a necessary element in designing and reporting research. Moreover, there seems also to be a general presumption that the ideal perspective is “societal”. In this paper we endorse the first principle but dissent from the second. A review of recommended perspectives is presented. The societal perspective is frequently not the one recommended. The societal perspective is shown to be less comprehensive than is commonly supposed, is inappropriate in many contexts and, in any case, is in general not a perspective to be determined independently of the context of a decision problem. Moreover, the selection of a perspective, societal or otherwise, is not the prerogative of analysts.
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Affiliation(s)
- Anthony Culyer
- Department of Economics & Related Studies, University of York, UK, York, YO10 5DD, UK.,Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, SW7 2AZ, UK.,Center for Global Development, Westminster Impact Hub, London, SW1Y 4TE, UK
| | - Yot Teerawattananon
- Department of Health, Ministry of Public Health, Thailand, Nonthaburi, 11000, Thailand
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10
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Culyer A, McCabe C, Briggs A, Claxton K, Buxton M, Akehurst R, Sculpher M, Brazier J. Searching for a threshold – Not so…. J Health Serv Res Policy 2016. [DOI: 10.1258/135581907781543003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Chafe R, Culyer A, Dobrow M, Coyte PC, Sawka C, O'Reilly S, Laing K, Trudeau M, Smith S, Hoch JS, Morgan S, Peacock S, Abbott R, Sullivan T. Access to cancer drugs in Canada: looking beyond coverage decisions. ACTA ACUST UNITED AC 2012; 6:27-36. [PMID: 22294989 DOI: 10.12927/hcpol.2011.22177] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine variation in patients' access to a set of cancer drugs through publicly funded provincial drug programs. DATA SOURCES/STUDY DESIGN We surveyed provincial drug program managers about their highest-expenditure intravenous and oral cancer drugs. We then investigated whether the same cancer drugs account for the highest expenditures across the provincial programs. We also compared the rates at which these drugs are accessed through these programs. PRINCIPAL FINDINGS While there is moderate consistency in the selection of cancer drugs that account for the highest provincial expenditures, considerable differences were found in the rates at which some drugs are accessed across provincial programs. CONCLUSIONS The study demonstrates the existence of interprovincial variation in publicly funded access to cancer drugs even after these drugs have been approved for public coverage.
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Affiliation(s)
- Roger Chafe
- Division of Pediatrics, Faculty of Medicine, Memorial University, St. John's, NL
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Abstract
The National Institute for Health and Clinical Excellence (NICE) is the principal provider of information about the evidence relating to effectiveness and cost-effectiveness in healthcare in the National Health Service of England and Wales. NICE regards quality as primarily to do with effectiveness, safety and the patient experience. In this paper we comment on the quality of evidence regarding these three and speculate about the consequences of widening the range of interventions for appraisal and taking more complete account of upstream determinants of health. We also comment on the type and quality of the evidence, as well as the way in which it is used, and the values--too often hidden--that permeate both the evidence and the way in which it is used.
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Affiliation(s)
- Anthony Culyer
- Ontario Research Chair in Health Policy and System Design at the University of Toronto and is a professor of economics at the University of York, England
| | - Michael Rawlins
- Founding chair of the National Institute for Health & Clinical Excellence, president of the Royal College of Physicians of London, and professor emeritus at the University of Newcastle
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13
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Abstract
The extent to which clinical and public health guidance developed by the National Institute for Health and Clinical Excellence (NICE) can effectively serve the public by improving quality and efficiency across the National Health Service (NHS) and the broader public sector depends largely on the quality and relevance of the available evidence which informs its decisions. There are well-established organizational and procedural links between NICE and academic and professional organizations that undertake evidence synthesis. However, there are fewer means for evidence gaps identified during the development of NICE guidance to lead to the commissioning of new prospective studies. In this paper, we discuss the importance of a publicly funded clinical and public health research agenda that includes new prospective studies aimed at addressing knowledge gaps identified by NICE. We describe the early experience of NICE and the National Institute for Health Research (NIHR) working together to articulate and commission research to inform best practice recommendations. We propose ways in which NICE can collaborate more effectively with research funders to improve the evidence base upon which it bases its recommendations.
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Affiliation(s)
- Kalipso Chalkidou
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tom Walley
- Old Infirmary, University of Liverpool, UK
| | - Anthony Culyer
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada and Centre for Health Economics, University of York, York, UK
| | | | - Andrew Hoy
- National Institute for Health and Clinical Excellence, London, UK
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Hurley J, Pasic D, Lavis J, Mustard C, Culyer A, Gnam W. Parallel Lines Do Intersect: Interactions between the Workers' Compensation and Provincial Publicly Financed Healthcare Systems in Canada. Healthc Policy 2008. [DOI: 10.12927/hcpol.2008.19925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Chalkidou K, Culyer A, Naidoo B, Littlejohns P. Cost-effective public health guidance: asking questions from the decision-maker's viewpoint. Health Econ 2008; 17:441-8. [PMID: 17764094 DOI: 10.1002/hec.1277] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In February 2004, in his assessment of the long-term financial viability of the NHS, Derek Wanless recommended the use of 'a consistent framework, such as the methodology developed by NICE, to evaluate the cost-effectiveness of interventions and initiatives across health care and public health'. One year later public health was added to NICE's remit and the new National Institute for Health and Clinical Excellence (NICE) was established, with amended statutory instruments to permit consideration of broader public sector costs when developing cost-effective guidance for public health. With the principle of 'a consistent framework' put forward by Wanless as the starting point, this paper provides an insight into the most challenging aspects of applying the principles of cost-effectiveness analysis in the public health context from the policymaker's perspective. It reflects on the long-term consequences of taking on responsibility for producing public health guidance on the Institute's overall approach to guidance development and describes the tension between striving for consistency and cross-evaluation comparability while ensuring that the methodological tools used are fit for the purpose of developing public health guidance.
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Affiliation(s)
- Kalipso Chalkidou
- Research and Development, National Institute for Health and Clinical Excellence, London, UK.
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Culyer A, McCabe C, Briggs A, Claxton K, Buxton M, Akehurst R, Sculpher M, Brazier J. Searching for a threshold, not setting one: the role of the National Institute for Health and Clinical Excellence. J Health Serv Res Policy 2007; 12:56-8. [PMID: 17244400 DOI: 10.1258/135581907779497567] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There has been much speculation about whether the National Institute for Health and Clinical Excellence (NICE) has, or ought to have, a 'threshold' figure for the cost of an additional quality-adjusted life-year above which a technology will not be recommended for use. We argue that it is not constitutionally appropriate for NICE to set such a threshold, which is properly the business of parliament. Instead, the task for NICE is as a 'threshold-searcher' - to seek to identify an optimal threshold incremental cost-effectiveness ratio, at the ruling rate of expenditure, that is consistent with the aim of the health service to maximize population health. This will involve the identification of technologies currently made available by the National Health Service that have incremental cost-effectiveness ratios above the threshold, and alternative uses for those resources in the shape of technologies not currently provided that fall below the threshold.
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Affiliation(s)
- Anthony Culyer
- Department of Economics and Related Studies, University of York, York, UK
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17
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Claxton K, Sculpher M, Culyer A, McCabe C, Briggs A, Akehurst R, Buxton M, Brazier J. Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion. Health Econ 2006; 15:1-4. [PMID: 16365910 DOI: 10.1002/hec.1081] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Brouwer and colleagues [1] argue that the reasons for specifying an equal discount rate for health outcomes and costs in the recent guidance on methods of technology appraisal issued by the National Institute for Clinical Excellence (NICE) [2] is both opaque and wrong. They argue that a lower rate should apply to health outcomes like QALYs. It is also claimed that the guidance on discounting represents a step backwards, that is both inconsistent with current theoretical insights and will prejudice the outcome of cost-effectiveness studies of preventive interventions.The reasoning behind the use of equal discount rates for costs and health outcomes is indeed not well developed in the published guidance. Nor does it reflect the debate that underpinned the guidance. We therefore welcome the opportunity to explain more completely the rationale in the minds of the principal authors of the current guidance.
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Anderson GM, Bronskill SE, Mustard CA, Culyer A, Alter DA, Manuel DG. Both clinical epidemiology and population health perspectives can define the role of health care in reducing health disparities. J Clin Epidemiol 2005; 58:757-62. [PMID: 16018910 DOI: 10.1016/j.jclinepi.2004.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 10/14/2004] [Accepted: 10/29/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare and contrast clinical epidemiology and population health perspectives on the role of health care in reducing socioeconomic disparities in health. STUDY DESIGN AND SETTING A review of concepts outlined in selected articles on population health and clinical epidemiology and a systematic literature search for randomized controlled trials (RCTs) of therapeutic interventions for cardiovascular disease that contained analysis of outcomes by socioeconomic status. RESULTS Population health has a focus on health disparities, particularly disparities related to socioeconomic status, and many of its proponents have a pessimistic view of the degree to which health care can reduce these disparities. Clinical epidemiology has a focus on the production of valid evidence on the impact of health care interventions; however, RCTs rarely report the impact of interventions across socioeconomic strata. Both population health and clinical epidemiology share the view that efficacy, effectiveness, and cost-effectiveness are all important in defining the impact of health care on health disparities. CONCLUSION Principles drawn from both population health and clinical epidemiology could be used to provide a clearer picture of the role that health care interventions can have on socioeconomic disparities in health and to identify implications for policy, research, and clinical practice.
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Affiliation(s)
- Geoffrey M Anderson
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, McMurrich Building, 2nd floor, 12 Queen's Park Crescent West, Toronto, Ontario M5S 1A8, Canada.
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Godfrey C, Parrott S, Eaton G, Culyer A, McDougall C. Can we model the impact of increased drug treatment expenditure on the U.K. drug market? Adv Health Econ Health Serv Res 2005; 16:257-75. [PMID: 17867243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This chapter introduces a simulation model to estimate the social costs of problem drug misusers in England and Wales, and how policies to increase the number of drug users in treatment may impact on both social costs and government expenditure. Consequences are divided into five domains--health, crime, social care, work, and driving. Social costs are estimated to be between pound 12 and pound 12.3 billion, and the total cost of government expenditure is around pound 3.5 billion. Increases in the numbers in treatment, are estimated to reduce social costs across a 5-year period by between pound 3.0 and pound 4.4 billion.
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Affiliation(s)
- Christine Godfrey
- Department of Health Sciences, Centre for Health Economics, University of York, UK
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