Some Factors to Consider when Using the Results of Economic Evaluation Studies at the Population Level

1994 ◽  
Vol 10 (3) ◽  
pp. 467-478 ◽  
Author(s):  
Reiner M. Leidl
Keyword(s):  
Economic Evaluation ◽  
Treatment Effectiveness ◽  
Evaluation Studies ◽  
Population Level ◽  
Medical Intervention ◽  
Community Capacity ◽  
Decision Makers ◽  
Time Perspectives ◽  
Patient Level ◽  
The Cost

AbstractThe cost-effectiveness of a medical intervention at the population level may deviate from that reported for evaluations at the patient level. It is important for researchers and decision makers to know about the relevance of externalities, phasing-in effects, treatment effectiveness in the community, capacity issues, and different time perspectives in the evaluation of an intervention.

scholarly journals The Cost-Effectiveness of Mobile Health (mHealth) Interventions for Older Adults: Systematic Review

2020 ◽  
Vol 17 (15) ◽  
pp. 5290
Author(s):  
Zartashia Ghani ◽  
Johan Jarl ◽  
Johan Sanmartin Berglund ◽  
Martin Andersson ◽  
Peter Anderberg
Keyword(s):  
Older Adults ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Empirical Evidence ◽  
Mobile Health ◽  
Evaluation Studies ◽  
Health Economic Evaluation ◽  
Reporting Quality ◽  
Economic Evaluations ◽  
The Cost

The objective of this study was to critically assess and review empirical evidence on the cost-effectiveness of Mobile Health (mHealth) interventions for older adults. We systematically searched databases such as Pubmed, Scopus, and Cumulative Index of Nursing and Allied Literature (CINAHL) for peer-reviewed economic evaluations published in English from 2007 to 2018. We extracted data on methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and assessed if this evidence supported the reported findings in terms of cost-effectiveness. The consolidated health economic evaluation reporting standards (CHEERS) checklist was used to assess the reporting quality of the included studies. Eleven studies were identified and categorized into two groups: complex smartphone communication and simple text-based communication. Substantial heterogeneity among the studies in terms of methodological approaches and types of intervention was observed. The cost-effectiveness of complex smartphone communication interventions cannot be judged due to lack of information. Limited evidence of cost-effectiveness was found for interventions related to simple text-based communications. Comprehensive economic evaluation studies are warranted to assess the cost-effectiveness of mHealth interventions designed for older adults.

scholarly journals Early Economic Evaluation of Diagnostic Technologies: Experiences of the NIHR Diagnostic Evidence Co-operatives

2019 ◽  
Vol 39 (7) ◽  
pp. 857-866 ◽  
Author(s):  
Lucy Abel ◽  
Bethany Shinkins ◽  
Alison Smith ◽  
Andrew J. Sutton ◽  
Gurdeep S. Sagoo ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Case Studies ◽  
Diagnostic Tests ◽  
Treatment Effectiveness ◽  
Early Stage ◽  
Early Model ◽  
The Cost ◽  
Diagnostic Technologies ◽  
Evidence Generation

Diagnostic tests are expensive and time-consuming to develop. Early economic evaluation using decision modeling can reduce commercial risk by providing early evidence on cost-effectiveness. The National Institute for Health Research Diagnostic Evidence Co-operatives (DECs) was established to catalyze evidence generation for diagnostic tests by collaborating with commercial developers; DEC researchers have consequently made extensive use of early modeling. The aim of this article is to summarize the experiences of the DECs using early modeling for diagnostics. We draw on 8 case studies to illustrate the methods, highlight methodological strengths and weaknesses particular to diagnostics, and provide advice. The case studies covered diagnosis, screening, and treatment stratification. Treatment effectiveness was a crucial determinant of cost-effectiveness in all cases, but robust evidence to inform this parameter was sparse. This risked limiting the usability of the results, although characterization of this uncertainty in turn highlighted the value of further evidence generation. Researchers evaluating early models must be aware of the importance of treatment effect evidence when reviewing the cost-effectiveness of diagnostics. Researchers planning to develop an early model of a test should also 1) consult widely with clinicians to ensure the model reflects real-world patient care; 2) develop comprehensive models that can be updated as the technology develops, rather than taking a “quick and dirty” approach that may risk producing misleading results; and 3) use flexible methods of reviewing evidence and evaluating model results, to fit the needs of multiple decision makers. Decision models can provide vital information for developers at an early stage, although limited evidence mean researchers should proceed with caution.

scholarly journals An Economic Evaluation of Triage Tools For Patients With Suspected Severe Injuries In England

2021 ◽  
Author(s):  
Daniel Pollard ◽  
Gordon Fuller ◽  
Steve Goodacre ◽  
Eveline A. J. van Rein ◽  
F. Waalwijk Job ◽  
...  
Keyword(s):  
Health Care ◽  
Economic Evaluation ◽  
Sensitivity And Specificity ◽  
Major Trauma ◽  
Cost Effective ◽  
Decision Makers ◽  
Life Years ◽  
Trauma Triage ◽  
The Cost ◽  
Injured Patients

Abstract BackgroundMany health care systems triage injured patients to major trauma centres (MTCs) or local hospitals by using triage tools and paramedic judgement. Triage tools are typically assessed by whether patients with an Injury Severity Score (ISS)≥16 go to an MTC and whether patients with an ISS<16 are sent to their local hospital. There is a trade‐off between sensitivity and specificity of triage tools, with the optimal balance being unknown. We conducted an economic evaluation of major trauma triage tools to identify which tool would be considered cost-effective by UK decision makers.MethodsA patient-level, probabilistic, mathematical model of a UK major trauma system was developed. Patients with an ISS≥16 who were only treated at local hospitals had worse outcomes compared to being treated in an MTC. Nine empirically derived triage tools, from a previous study, were examined so we assessed triage tools with realistic trade-offs between triage tool sensitivity and specificity. Lifetime costs, lifetime quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each tool and compared to maximum acceptable ICERs (MAICERs) in England. ResultsFour tools had ICERs within the normal range of MAICERs used by English decision makers (£20,000 to £30,000 per QALY gained). A low sensitivity (28.4%) and high specificity (88.6%) would be cost-effective at the lower end of this range while higher sensitivity (87.5%) and lower specificity (62.8%) was cost-effective towards the upper end of this range. These results were sensitive to the cost of MTC admissions and whether MTCs had a benefit for patients with an ISS between 9 and 15. ConclusionsThe cost-effective triage tool depends on the English decision maker’s MAICER for this health problem. In the usual range of MAICERs, cost-effective prehospital trauma triage involves clinically suboptimal sensitivity, with a proportion of seriously injured patients (at least 10%) being initially transported to local hospitals. High sensitivity trauma triage requires development of more accurate decision rules; research to establish if patients with an ISS between 9 and 15 benefit from MTCs; or, inefficient use of health care resources to manage patients with less serious injuries at MTCs.

scholarly journals Cost of oropharyngeal dysphagia after stroke: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022775 ◽  
Author(s):  
Sergio Marin ◽  
Mateu Serra-Prat ◽  
Omar Ortega ◽  
Pere Clavé
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Respiratory Infections ◽  
Evaluation Studies ◽  
Hospital Costs ◽  
Oropharyngeal Dysphagia ◽  
Indirect Costs ◽  
Registration Number ◽  
Hospital Stays ◽  
The Cost

IntroductionOropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute in-hospital costs from OD complications, there are other costs related to poststroke OD such as direct non-healthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients.Methods and analysisA systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured.Ethics and disseminationThe results of this systematic review will be published in a peer-reviewed journal.PROSPERO registration numberCRD42018099977.

Precision QALYs, Precisely Unjust

2019 ◽  
Vol 28 (3) ◽  
pp. 439-449
Author(s):  
LEONARD M. FLECK
Keyword(s):  
Health Care ◽  
Population Level ◽  
Medical Intervention ◽  
Social Utility ◽  
Health Care Intervention ◽  
Use Of Resources ◽  
Life Years ◽  
Intervention Costs ◽  
The Cost ◽  
Allocation Decisions

Abstract:Warwick Heale has recently defended the notion of individualized and personalized Quality-Adjusted Life Years (QALYs) in connection with health care resource allocation decisions. Ordinarily, QALYs are used to make allocation decisions at the population level. If a health care intervention costs £100,000 and generally yields only two years of survival, the cost per QALY gained will be £50,000, far in excess of the £30,000 limit per QALY judged an acceptable use of resources within the National Health Service in the United Kingdom. However, if we know with medical certainty that a patient will gain four extra years of life from that intervention, the cost per QALY will be £25,000. Heale argues fairness and social utility require such a patient to receive that treatment, even though all others in the cohort of that patient might be denied that treatment (and lose two years of potential life). Likewise, Heale argues that personal commitments of an individual (religious or otherwise), that determine how they value a life-year with some medical intervention, ought to be used to determine the value of a QALY for them. I argue that if Heale’s proposals were put into practice, the result would often be greater injustice. In brief, requirements for the just allocation of health care resources are more complex than pure cost-effectiveness analysis would allow.

scholarly journals A protocol for a systematic literature review of economic evaluation studies of interventions to address antimicrobial resistance

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Aparna Ananthakrishnan ◽  
Chris Painter ◽  
Yot Teerawattananon
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Antimicrobial Resistance ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Evaluation Studies ◽  
Grey Literature ◽  
World Health ◽  
Economic Evaluations ◽  
The Cost

Abstract Background Antimicrobial resistance (AMR) is accelerated by the widespread and often indiscriminate use of antimicrobials in humans, animals, and the environment. In 2015, the World Health Organization recognised AMR as one of the top ten global health threats, due to its potential to neutralise humanity’s advancements in western medicine by enabling the emergence of new strains of existing pathogens, many of which have no available treatments. Over the past decade, several countries, including those in low- and middle-income contexts, have started implementing interventions to tackle AMR. However, economic evidence regarding the cost-effectiveness of these interventions remains weak. To address this evidence gap, we will conduct a systematic literature review to provide a comprehensive summary on the value for money of different AMR interventions. Methods We aim to conduct a systematic literature review of all available economic evaluations on interventions addressing AMR and will provide a narrative synthesis of our findings. Systematic searches for relevant studies will be performed across all suitable databases as well as in grey literature sources such as unpublished studies, reports, and other relevant documents. All economic evaluation studies will be included as long as they report an economic outcome and have stated that the analysed intervention will reduce antimicrobial resistance or antimicrobial use in the abstract. Those studies reporting clinical endpoints alone will be excluded. Selection for final inclusion and data extraction will be performed by two independent reviewers. Discussion The review will be one of the first of its kind, and the most recent, to systematically review literature on the cost-effectiveness of AMR interventions, an important evidence gap in the economics of AMR. The findings will enable policy and decision-makers, particularly in resource-constrained settings, to better use available resources when selecting interventions to address AMR burdens, Systematic review registration PROSPERO CRD42020190310

scholarly journals Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 426 ◽  
Author(s):  
Neily Zakiyah ◽  
Widya N. Insani ◽  
Auliya A. Suwantika ◽  
Jurjen van der Schans ◽  
Maarten J. Postma
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Evaluation Studies ◽  
Pneumococcal Vaccination ◽  
Cost Effective ◽  
Asian Countries ◽  
Life Years ◽  
Key Drivers ◽  
The Cost

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.

Opportunity cost of the dermatologist’s consulting time in the economic evaluation of teledermatology

2016 ◽  
Vol 23 (7) ◽  
pp. 657-664 ◽  
Author(s):  
Fernando Fuertes-Guiró ◽  
Montserrat Girabent-Farrés
Keyword(s):  
Economic Evaluation ◽  
Opportunity Cost ◽  
Evaluation Studies ◽  
Meta Analysis ◽  
Economic Cost ◽  
Economic Assessment ◽  
Remote Consultation ◽  
A Value ◽  
The Cost ◽  
Consultation Time

Introduction This study, through a systematic review and meta-analysis, has sought to demonstrate that the opportunity cost is a value to take into account in studies of economic cost in telemedicine, illustrated through the time of the dermatologist’s consultation in teledermatology and traditional consultation. Methods Economic evaluation studies have been identified that compare teledermatology and traditional dermatological consultation during the period 1998–2015. We carried out a meta-analysis considering the work cost and the dermatologist’s consultation time, analysing their differences. The opportunity cost represented by these differences in the dermatological remote consultation time was subsequently calculated based on the design of a cost/time variable. Results It was not possible to meta-analyse the cost of the dermatologist’s consultation due to insufficient standardized complete data. It was possible to carry out a meta-analysis of the consultation time, and three articles were selected (2945 patients). Teledermatology accounts for more time (7.54 min) than conventional consultation ( p < 0.00001) and this difference is an opportunity cost of teledermatology of €29.25 per each remote consultation, with a unitary factor cost/time of 3.88€/minute. Conclusions There is no unanimity in the literature regarding which of the two procedures is cheaper; further studies with the necessary standardized variables are required. In this meta-analysis, teledermatology takes more time than a conventional dermatology consultation, which leads to an opportunity cost, increasing the total cost of consultation. The opportunity cost is a value that should be included in an analysis of economic costs, in the context of an economic assessment, when we evaluate a health activity.

scholarly journals A Protocol for a Systematic Literature Review of Economic Evaluation Studies of Interventions to Address Antimicrobial Resistance

2020 ◽  
Author(s):  
Aparna Ananthakrishnan ◽  
Chris Painter ◽  
Yot Teerawattananon
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Antimicrobial Resistance ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Evaluation Studies ◽  
Grey Literature ◽  
World Health ◽  
Economic Evaluations ◽  
The Cost

Abstract Background: Antimicrobial resistance (AMR) is accelerated by the widespread and often indiscriminate use of antimicrobials in humans, animals, and the environment. In 2015, the World Health Organization recognised AMR as one of the top ten global health threats, due to its potential to neutralise humanity’s advancements in western medicine by enabling the emergence of new strains of existing pathogens, many of which have no available treatments. Over the past decade, several countries, including those in low- and middle- income contexts, have started implementing interventions to tackle AMR. However, economic evidence regarding the cost-effectiveness of these interventions remain weak. To address this evidence gap, we will conduct a systematic literature review to provide a comprehensive summary on the value for money of different AMR interventions.Methods: We aim to conduct a systematic literature review of all available economic evaluations on interventions addressing AMR and will provide a narrative synthesis of our findings. Systematic searches for relevant studies will be performed across all suitable databases as well as in grey literature sources such as unpublished studies, reports, and other relevant documents. All economic evaluation studies will be included as long as they report an economic outcome. Those studies reporting clinical endpoints alone will be excluded. Selection for final inclusion and data extraction will be performed by two independent reviewers. Discussion: The review will be one of the first of its kind, and the most recent, to systematically review literature on the cost-effectiveness of AMR interventions, an important evidence gap in the economics of AMR. The findings will enable policy and decision-makers, particularly in resource-constrained settings, to better use available resources when selecting interventions to address AMR burdens, Systematic review registration: PROSPERO (Awaiting registration number)

scholarly journals ECONOMIC EVALUATION FOR HEALTH ADVOCACY AND INFORMED POLICY

2021 ◽  
Vol 9 (2) ◽  
pp. 202
Author(s):  
Maznah Dahlui ◽  
Thinni Nurul Rochmah ◽  
Ernawaty Ernawaty ◽  
Djazuly Chalidyanto
Keyword(s):  
Economic Evaluation ◽  
Policy Making ◽  
Evaluation Studies ◽  
Care Program ◽  
Health Intervention ◽  
Health Programs ◽  
Monitoring And Control ◽  
Alternative Health ◽  
Public Health Monitoring ◽  
The Cost

Background: Healthcare resources are limited therefore, adequate, appropriate and timely allocation of resources are important. Decision to invest on health care program can be made from the analysis of the information obtained on the cost and consequences of the various alternative health programs, often known as economic evaluation of health interventions.Aims: This write-up emphasizes on the importance of evidence driven policy of health intervention whereby economic evaluation should be performed to indicate whether investment on health intervention would benefit the country.Methods: Literature review on economic evaluation studies conducted by the first author during her 14 years tenure as academician had been performed. Various studies which applied the cost-effectiveness analysis tools to economically evaluate health interventions and programs in Malaysia and other countries are shared.Results: The economic evaluation studies cut across different programs such as disease prevention and treatment, public health monitoring and control, and implications of health issues to the healthcare system. Many of the findings have been used for advocacy to shape the delivery of more effective health intervention programs in the country.Conclusion: The country will benefit from economic evaluation studies which could provide evidence to assist in policy making on health programs for the country.Keywords: economic evaluation, health programs, policy making

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