scholarly journals ISPOR’s Initiative on US Value Assessment Frameworks: The Use of Cost-Effectiveness Research in Decision Making among US Insurers

2018 ◽  
Vol 21 (2) ◽  
pp. 166-168 ◽  
Author(s):  
Brian Solow ◽  
Edmund J. Pezalla
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Effectiveness Research ◽  
Value Assessment

DECISION-COMPONENTS OF NICE'S TECHNOLOGY APPRAISALS ASSESSMENT FRAMEWORK

2018 ◽  
Vol 34 (2) ◽  
pp. 163-171 ◽  
Author(s):  
Joost de Folter ◽  
Mark Trusheim ◽  
Pall Jonsson ◽  
Sarah Garner
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Text Analysis ◽  
Visual Representations ◽  
Clinical Effectiveness ◽  
Value Assessment ◽  
Decision Factors ◽  
Complex Information ◽  
Decision Making Processes ◽  
New Treatment

Objectives: Value assessment frameworks have gained prominence recently in the context of U.S. healthcare. Such frameworks set out a series of factors that are considered in funding decisions. The UK's National Institute of Health and Care Excellence (NICE) is an established health technology assessment (HTA) agency. We present a novel application of text analysis that characterizes NICE's Technology Appraisals in the context of the newer assessment frameworks and present the results in a visual way.Methods: A total of 243 documents of NICE's medicines guidance from 2007 to 2016 were analyzed. Text analysis was used to identify a hierarchical set of decision factors considered in the assessments. The frequency of decision factors stated in the documents was determined and their association with terms related to uncertainty. The results were incorporated into visual representations of hierarchical factors.Results: We identified 125 decision factors, and hierarchically grouped these into eight domains: Clinical Effectiveness, Cost Effectiveness, Condition, Current Practice, Clinical Need, New Treatment, Studies, and Other Factors. Textual analysis showed all domains appeared consistently in the guidance documents. Many factors were commonly associated with terms relating to uncertainty. A series of visual representations was created.Conclusions: This study reveals the complexity and consistency of NICE's decision-making processes and demonstrates that cost effectiveness is not the only decision-criteria. The study highlights the importance of processes and methodology that can take both quantitative and qualitative information into account. Visualizations can help effectively communicate this complex information during the decision-making process and subsequently to stakeholders.

scholarly journals A referral aid for smoking cessation interventions in primary care: study protocol for a randomized controlled trial

2021 ◽  
Vol 22 ◽  
Author(s):  
Daniëlle N. Zijlstra ◽  
Jean W.M. Muris ◽  
Catherine Bolman ◽  
J. Mathis Elling ◽  
Vera E.R.A. Knapen ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Structural Equation ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Informed Decision ◽  
Equation Modeling ◽  
Informed Decision Making

Abstract Background: To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. Methods: Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. Discussion: This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.

Value assessment of antimicrobials and the implications for development, access, and funding of effective treatments: Australian stakeholder perspective

2020 ◽  
pp. 1-7
Author(s):  
Nadine T. Hillock ◽  
Tracy L. Merlin ◽  
Jonathan Karnon ◽  
John Turnidge ◽  
Jaklin Eliott
Keyword(s):  
Cost Effectiveness ◽  
Healthcare Resource ◽  
Economic Evaluations ◽  
Value Assessment ◽  
Antimicrobial Drugs ◽  
Policy Makers ◽  
Stakeholder Perspective ◽  
Definition Of ◽  
The Impact ◽  
Potential Use

Abstract Background The frameworks used by Health Technology Assessment (HTA) agencies for value assessment of medicines aim to optimize healthcare resource allocation. However, they may not be effective at capturing the value of antimicrobial drugs. Objectives To analyze stakeholder perceptions regarding how antimicrobials are assessed for value for reimbursement purposes and how the Australian HTA framework accommodates the unique attributes of antimicrobials in cost-effectiveness evaluation. Methods Eighteen individuals representing the pharmaceutical industry or policy-makers were interviewed. Interviews were transcribed verbatim, coded, and thematically analyzed. Results Key emergent themes were that reimbursement decision-making should consider the antibiotic spectrum when assessing value, risk of shortages, the impact of procurement processes on low-priced comparators, and the need for methodological transparency when antimicrobials are incorporated into the economic evaluation of other treatments. Conclusions Participants agreed that the current HTA framework for antimicrobial value assessment is inadequate to properly inform funding decisions, as the contemporary definition of cost-effectiveness fails to explicitly incorporate the risk of future resistance. Policy-makers were uncertain about how to incorporate future resistance into economic evaluations without a systematic method to capture costs avoided due to good stewardship. Lacking financial reward for the benefits of narrower-spectrum antimicrobials, companies will likely focus on developing broad-spectrum agents with wider potential use. The perceived risks of shortages have influenced the funding of generic antimicrobials in Australia, with policy-makers suggesting a willingness to pay more for assured supply. Although antibiotics often underpin the effectiveness of other medicines, it is unclear how this is incorporated into economic models.

scholarly journals Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

2019 ◽  
Vol 69 (689) ◽  
pp. e809-e818 ◽  
Author(s):  
Sophie Chima ◽  
Jeanette C Reece ◽  
Kristi Milley ◽  
Shakira Milton ◽  
Jennifer G McIntosh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Decision Support ◽  
Cost Effectiveness ◽  
Cancer Diagnosis ◽  
Decision Support Tools ◽  
Diagnostic Decision ◽  
Support Tools ◽  
Diagnostic Decision Making

BackgroundThe diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.AimTo investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.Design and settingA systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.MethodPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.ResultsOf the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.ConclusioneCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

scholarly journals Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands: A State Transition Model

2020 ◽  
Vol 40 (8) ◽  
pp. 1003-1019
Author(s):  
Ingrid E. H. Kremer ◽  
Mickael Hiligsmann ◽  
Josh Carlson ◽  
Marita Zimmermann ◽  
Peter J. Jongen ◽  
...  
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Shared Decision Making ◽  
State Transition ◽  
Transition Model ◽  
Shared Decision ◽  
Relapsing Remitting ◽  
State Transition Model ◽  
The Cost ◽  
Relapsing Remitting Multiple Sclerosis

Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient’s discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of €17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown.

The Prescription as Final Common Pathway

1995 ◽  
Vol 11 (3) ◽  
pp. 384-390 ◽  
Author(s):  
Jerry Avorn
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Health Economics ◽  
Medical Care ◽  
Clinical Medicine ◽  
Decision Science ◽  
Therapeutic Decision ◽  
Common Pathway ◽  
Final Common Pathway ◽  
Therapeutic Decision Making

AbstractThere is an informational void about Pharmaceuticals in the training of most doctors, despite the importance of the prescription in medical care. The writing of the prescription is the final common pathway in therapeutic decision making, which involves such diverse forces and disciplines as anthropology, decision science, health economics, ethics, and politics, as well as pharmacology and clinical medicine. Programs to improve the precision and cost-effectiveness of doctors' prescribing must consider all of these factors if pharmacotherapeutics are to be used optimally.

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