VP13 Transferability Instrument Of Health Economic Evaluations For Chile

2019 ◽  
Vol 35 (S1) ◽  
pp. 78-78
Author(s):  
Victoria Hurtado-Meneses ◽  
Catherine De la Puente ◽  
Marianela Castillo ◽  
Sergio Poblete
Keyword(s):  
Economic Evaluation ◽  
De Novo ◽  
Research Question ◽  
Cost Effective ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Reference Case ◽  
Knock Out ◽  
Cost Treatment ◽  
Assess Quality

IntroductionAny technology submission for the high-cost treatment fund in Chile requires an economic evaluation; however, this is time consuming and given its high number, it is not possible to inform decisions within the established period of time. This presentation proposes a guide for the transferability of international economic evaluation results to our national context, with the intention to inform decision makers in a brief period of time.MethodsA literature review on transferability analysis, tools and instruments to perform transferability analysis and on how to assess quality of economic evaluations was conducted. In addition, a workshop was held to discuss the proposal with other relevant researchers, in order to receive feedback.ResultsThe proposed instrument is based on Welte and consists of: (i) a research question is formulated and a systematic review of economic evaluations is conducted, (ii) the three Welte knock-out criteria are applied to these results and, if these are met, the articles pass to the next stage, (iii) a scored comparison based on twelve criteria is conducted on the articles and each article is compared against the Chilean (economic) reference case, (iv) high-scored economic evaluations will be grouped according of their incremental cost-effectiveness ratio (ICER). If all ICERs do not converge, to the same conclusion, the intervention would not be transferable. If the ICERs of these studies converge, then the results will be compared against the national threshold. If the ICERs are greater than the threshold, the intervention would not be cost-effective. If the ICERs are lower than the threshold, then the intervention would be cost-effective in Chile.ConclusionsDespite a de novo analysis still being the gold standard to inform decision makers, the proposed instrument could be used as an alternative, given the short time limit and the scarcity of qualified human resources.

scholarly journals An Introduction to Economic Evaluation: What's in a Name?

2005 ◽  
Vol 50 (3) ◽  
pp. 159-166 ◽  
Author(s):  
Jeffrey S Hoch ◽  
Carolyn S Dewa
Keyword(s):  
Economic Evaluation ◽  
Evaluation Method ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Economic Study ◽  
Value Judgment ◽  
A Value ◽  
Different Types ◽  
New Treatment ◽  
Evaluation Techniques

Objective: This paper describes the main types of economic evaluation techniques. Method: To examine the strengths and limitations of different types of economic evaluations, we used a hypothetical example to review the reasoning underlying each method and to illustrate when it is appropriate to use each method. Results: The choice of economic evaluation method reflects a decision about what should represent “success” and how success should be valued. Measures of benefit and cost must be considered systematically and simultaneously. Claiming that a new treatment is cost-effective requires making a value judgment based on the personal beliefs of the claimant. Even when cost and effect data are objective, a verdict of cost-effective is subjective. The conclusions of an economic study can change significantly, depending on which patient outcome is used to measure success. Conclusions: Clinicians must be sure that important patient outcomes are not excluded from economic evaluations. Economic evaluation is a process designed to produce an estimate rather than a decision. New treatment can be more costly and still be cost-effective (if the extra benefit is valued more than the extra cost to produce it). However, since economic evaluation does not explicitly consider a decision maker's available budget, a new treatment can be deemed cost-effective but too expensive to approve.

scholarly journals A Systematic Review of Methods, Study Quality, and Results of Economic Evaluation for Childhood and Adolescent Obesity Intervention

2019 ◽  
Vol 16 (3) ◽  
pp. 485 ◽  
Author(s):  
Mandana Zanganeh ◽  
Peymane Adab ◽  
Bai Li ◽  
Emma Frew
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Evidence Synthesis ◽  
Evaluation Studies ◽  
Cost Effective ◽  
Adolescent Obesity ◽  
Economic Evaluations ◽  
Full Economic Evaluation ◽  
Childhood And Adolescent Obesity

Many suggested policy interventions for childhood and adolescent obesity have costs and effects that fall outside the health care sector. These cross-sectorial costs and consequences have implications for how economic evaluation is applied and although previous systematic reviews have provided a summary of cost-effectiveness, very few have conducted a review of methods applied. We undertook this comprehensive review of economic evaluations, appraising the methods used, assessing the quality of the economic evaluations, and summarising cost-effectiveness. Nine electronic databases were searched for full-economic evaluation studies published between January 2001 and April 2017 with no language or country restrictions. 39 economic evaluation studies were reviewed and quality assessed. Almost all the studies were from Western countries and methods were found to vary by country, setting and type of intervention. The majority, particularly “behavioural and policy” preventive interventions, were cost-effective, even cost-saving. Only four interventions were not cost effective. This systematic review suggests that economic evaluation of obesity interventions is an expanding area of research. However, methodological heterogeneity makes evidence synthesis challenging. Whilst upstream interventions show promise, an expanded and consistent approach to evaluate cost-effectiveness is needed to capture health and non-health costs and consequences.

scholarly journals Challenges in synthesising cost-effectiveness estimates

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Gemma E. Shields ◽  
Jamie Elvidge
Keyword(s):  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Study Designs

AbstractEconomic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.

Resource allocation and economic evaluation in Australia's healthcare system

2011 ◽  
Vol 35 (3) ◽  
pp. 278 ◽  
Author(s):  
Abdolvahab Baghbanian ◽  
Ian Hughes ◽  
Freidoon A. Khavarpour
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Healthcare Decision ◽  
Effectiveness Analysis ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective. To explore dimensions and varieties of economic evaluations that healthcare decision-makers do or do not use. Design. Web-based survey. Setting and participants. A purposive sample of Australian healthcare decision-makers was recruited by direct invitation through email. All were invited to complete an online questionnaire derived from the EUROMET 2004 survey. Results. A total of 91 questionnaires were analysed. Almost all participants were involved in financial resource allocations. Most commonly, participants based their decisions on patient needs, effectiveness of interventions, cost of interventions or overall budgetary effect, and policy directives. Evidence from cost-effectiveness analysis was used by half of the participants. Timing, ethical issues and lack of knowledge about economic evaluation were the most significant barriers to the use of economic evaluations in resource allocation decisions. Most participants reported being moderately to very familiar with the cost-effectiveness analysis. There was a general impression that evidence from economic evaluations should play a larger role in the future. Conclusions. Evidence from health economic evaluations may provide valuable information in some decisions; however, at present, it is not central to many decisions. The study suggests that, for economic evaluation to be helpful in real-life policy decisions, it has to be placed into context – a context which is complex, political and often resistant to voluntary change. What is known about the topic? There are increasing calls for the use of evidence from formal economic evaluations to improve the quality of healthcare decision making; however, it is widely acknowledged that such evidence, as presently constituted, is underused in its influence on allocation decisions. What does this paper add? This study highlights that resource allocation decisions cannot be purely based on the use of technical, economic data or systematic evidence-based reviews. In order to exploit the full potential value of economic evaluations, researchers need to make better sense of decision contexts at specific times and places. What are the implications for practitioners? The study has the potential to expand researchers and policy-makers’ understanding of the limited use of economic evaluation in decision-making. It produces evidence that decision-making in Australia’s healthcare system is not or cannot be a fully rational bounded process. Economic evaluation is used in some contexts, where information is accurate, complete and available.

scholarly journals Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies

2016 ◽  
Vol 2016 ◽  
pp. 1-14 ◽  
Author(s):  
Koffi Alouki ◽  
Hélène Delisle ◽  
Clara Bermúdez-Tamayo ◽  
Mira Johri
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Economic Evaluation ◽  
Primary Prevention ◽  
Latin American ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Lifestyle Interventions ◽  
Obesity Control

Objective. To summarize key findings of economic evaluations of lifestyle interventions for the primary prevention of type 2 diabetes (T2D) in high-risk subjects.Methods. We conducted a systematic review of peer-reviewed original studies published since January 2009 in English, French, and Spanish. Eligible studies were identified through relevant databases including PubMed, Medline, National Health Services Economic Evaluation, CINHAL, EconLit, Web of sciences, EMBASE, and the Latin American and Caribbean Health Sciences Literature. Studies targeting obesity were also included. Data were extracted using a standardized method. The BMJ checklist was used to assess study quality. The heterogeneity of lifestyle interventions precluded a meta-analysis.Results. Overall, 20 studies were retained, including six focusing on obesity control. Seven were conducted within trials and 13 using modeling techniques. T2D prevention by physical activity or diet or both proved cost-effective according to accepted thresholds, except for five inconclusive studies, three on diabetes prevention and two on obesity control. Most studies exhibited limitations in reporting results, primarily with regard to generalizability and justification of selected sensitivity parameters.Conclusion. This confirms that lifestyle interventions for the primary prevention of diabetes are cost-effective. Such interventions should be further promoted as sound investment in the fight against diabetes.

scholarly journals How has implementation been incorporated in health technology assessments in the United Kingdom? A systematic rapid review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Robert Heggie ◽  
Kathleen Boyd ◽  
Olivia Wu
Keyword(s):  
Economic Evaluation ◽  
Health Research ◽  
Research Question ◽  
Behavioural Change ◽  
Complex Interventions ◽  
Cost Effective ◽  
Health Technology ◽  
Rapid Review ◽  
Routine Practice ◽  
Effective Interventions

Abstract Objectives Health interventions in a clinical setting may be complex. This is particularly true of clinical interventions which require systems reorganization or behavioural change, and/or when implementation involves additional challenges not captured within a clinical trial setting. Medical Research Council guidance on complex interventions highlights the need to consider economic evaluation alongside implementation. However, the extent to which this guidance has been adhered to, and how, is unclear. The failure to incorporate implementation within the evaluation of an intervention may hinder the translation of research findings into routine practice. This will have consequences for patient care. This study examined the methods used to address implementation within health research conducted through funding from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. Methods We conducted a rapid review using a systematic approach. We included all NIHR HTA monographs which contained the word “implementation” within the title or abstract published between 2014 and 2020. We assessed the studies according to existing recommendations for specifying and reporting implementation approaches in research. Additional themes which were not included in the recommendation, but were of particular relevance to our research question, were also identified and summarized in a narrative synthesis. Results The extent to which implementation was formally incorporated, and defined, varied among studies. Methods for examining implementation ranged from single stakeholder engagement events to the more comprehensive process evaluation. There was no obvious pattern as to whether approaches to implementation had evolved over recent years. Approximately 50% (22/42) of studies included an economic evaluation. Of these, two studies included the use of qualitative data obtained within the study to quantitatively inform aspects relating to implementation and economic evaluation in their study. Discussion A variety of approaches were identified for incorporating implementation within an HTA. However, they did not go far enough in terms of incorporating implementation into the actual design and evaluation. To ensure the implementation of clinically effective and cost-effective interventions, we propose that further guidance on how to incorporate implementation within complex interventions is required. Incorporating implementation into economic evaluation provides a step in this direction.

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.

Economic evaluations of videoconference and telephone consultations in primary care: A systematic review

2021 ◽  
pp. 1357633X2110433
Author(s):  
Keshia R De Guzman ◽  
Centaine L Snoswell ◽  
Liam J Caffery ◽  
Anthony C Smith
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Minimization ◽  
Health Economic Evaluation ◽  
Reporting Quality ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Published Evidence

Introduction Telehealth services using videoconference and telephone modalities have been increasing exponentially in primary care since the coronavirus pandemic. The challenge now is ensuring that these services remain sustainable. This review investigates the cost-effectiveness of videoconference and telephone consultations in primary care settings, by summarizing the available published evidence. Methods A systematic search of PubMed, Embase, Scopus, and CINAHL databases was used to identify articles published from January 2000 to July 2020, using keyword synonyms for telehealth, primary care, and economic evaluation. Databases were searched, and title, abstract, and full-text reviews were conducted. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. Results Twenty articles were selected for inclusion, with 12 describing telephone triage services, seven describing telehealth substitution services, and one describing another telehealth service in primary care. These services were delivered by nurses, doctors, and allied health clinicians. Of the 20 included studies, 11 used cost analyses, five used cost-minimization analyses, and four used one or more methods, including either a cost–consequence analysis, a cost–utility analysis, or a cost-effectiveness analysis. Conclusions Telephone and videoconference consultations in primary care were cost-effective to the health system when deemed clinically appropriate, clinician when time was used efficiently, and when overall demand on health services was reduced. The societal benefits of telehealth consultations should be considered an important part of telehealth planning and should influence funding reform decisions for telehealth services in primary care.

OP68 Methods For The Economic Evaluation Of Precision Medicine

2018 ◽  
Vol 34 (S1) ◽  
pp. 24-25
Author(s):  
Reka Pataky ◽  
Dean Regier
Keyword(s):  
Economic Evaluation ◽  
Precision Medicine ◽  
Research Question ◽  
Analytical Framework ◽  
Covariate Adjustment ◽  
Economic Evaluations ◽  
Molecular Characteristics ◽  
Net Benefit ◽  
Individualized Care ◽  
Analytical Frameworks

Introduction:Methods that accommodate heterogeneity in outcomes are not widely used in economic evaluation. With the growth of precision medicine (PM), where choice of treatment is informed by the molecular characteristics of the patient or disease, we expect to see greater heterogeneity in effectiveness and cost of interventions. Our objective was to compare analytical frameworks for valuing heterogeneity in economic evaluation, and consider their strengths and weaknesses for applications in PM.Methods:We conducted a literature review to identify papers that proposed an analytical framework for economic evaluation of a health intervention, and that placed a value on heterogeneous effects. We compared the frameworks considering the purpose of the analysis, including where in the product lifecycle the framework could be used, the types of PM interventions where the framework could be applied, and its ability to address methodological challenges of evaluating PM.Results:Five analytical frameworks were identified: covariate adjustment methods, value of stratification, value of heterogeneity (VoH), expected value of individualized care (EVIC), and loss with respect to efficient diffusion (LED) metrics. Each framework addresses a slightly different research question, and is suited to different settings and interventions. With the exception of covariate adjustment, all focus on maximizing net benefit within certain constraints and quantify the opportunity cost of ignoring heterogeneity. Only VoH considers the relationship between heterogeneity and uncertainty, and no framework explicitly includes the cost or uncertainty associated with identifying subgroups.Conclusions:The ability to value heterogeneity is a critical component of economic evaluations of PM. The choice of an appropriate analytical framework will help strengthen the quality of economic evidence available to support health technology assessment of PM technologies, informing PM adoption decisions, and supporting efficient allocation of health care resources.

scholarly journals Molecular testing for Lynch syndrome in people with colorectal cancer: systematic reviews and economic evaluation

2017 ◽  
Vol 21 (51) ◽  
pp. 1-238 ◽  
Author(s):  
Tristan Snowsill ◽  
Helen Coelho ◽  
Nicola Huxley ◽  
Tracey Jones-Hughes ◽  
Simon Briscoe ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Lynch Syndrome ◽  
Diagnostic Test ◽  
Promoter Methylation ◽  
Cost Effective ◽  
Diagnostic Test Accuracy ◽  
Economic Evaluations ◽  
Test Accuracy ◽  
Long Term Outcomes

BackgroundInherited mutations in deoxyribonucleic acid (DNA) mismatch repair (MMR) genes lead to an increased risk of colorectal cancer (CRC), gynaecological cancers and other cancers, known as Lynch syndrome (LS). Risk-reducing interventions can be offered to individuals with known LS-causing mutations. The mutations can be identified by comprehensive testing of the MMR genes, but this would be prohibitively expensive in the general population. Tumour-based tests – microsatellite instability (MSI) and MMR immunohistochemistry (IHC) – are used in CRC patients to identify individuals at high risk of LS for genetic testing.MLH1(MutL homologue 1) promoter methylation andBRAFV600E testing can be conducted on tumour material to rule out certain sporadic cancers.ObjectivesTo investigate whether testing for LS in CRC patients using MSI or IHC (with or withoutMLH1promoter methylation testing andBRAFV600E testing) is clinically effective (in terms of identifying Lynch syndrome and improving outcomes for patients) and represents a cost-effective use of NHS resources.Review methodsSystematic reviews were conducted of the published literature on diagnostic test accuracy studies of MSI and/or IHC testing for LS, end-to-end studies of screening for LS in CRC patients and economic evaluations of screening for LS in CRC patients. A model-based economic evaluation was conducted to extrapolate long-term outcomes from the results of the diagnostic test accuracy review. The model was extended from a model previously developed by the authors.ResultsTen studies were identified that evaluated the diagnostic test accuracy of MSI and/or IHC testing for identifying LS in CRC patients. For MSI testing, sensitivity ranged from 66.7% to 100.0% and specificity ranged from 61.1% to 92.5%. For IHC, sensitivity ranged from 80.8% to 100.0% and specificity ranged from 80.5% to 91.9%. When tumours showing low levels of MSI were treated as a positive result, the sensitivity of MSI testing increased but specificity fell. No end-to-end studies of screening for LS in CRC patients were identified. Nine economic evaluations of screening for LS in CRC were identified. None of the included studies fully matched the decision problem and hence a new economic evaluation was required. The base-case results in the economic evaluation suggest that screening for LS in CRC patients using IHC,BRAFV600E andMLH1promoter methylation testing would be cost-effective at a threshold of £20,000 per quality-adjusted life-year (QALY). The incremental cost-effectiveness ratio for this strategy was £11,008 per QALY compared with no screening. Screening without tumour tests is not predicted to be cost-effective.LimitationsMost of the diagnostic test accuracy studies identified were rated as having a risk of bias or were conducted in unrepresentative samples. There was no direct evidence that screening improves long-term outcomes. No probabilistic sensitivity analysis was conducted.ConclusionsSystematic review evidence suggests that MSI- and IHC-based testing can be used to identify LS in CRC patients, although there was heterogeneity in the methods used in the studies identified and the results of the studies. There was no high-quality empirical evidence that screening improves long-term outcomes and so an evidence linkage approach using modelling was necessary. Key determinants of whether or not screening is cost-effective are the accuracy of tumour-based tests, CRC risk without surveillance, the number of relatives identified for cascade testing, colonoscopic surveillance effectiveness and the acceptance of genetic testing. Future work should investigate screening for more causes of hereditary CRC and screening for LS in endometrial cancer patients.Study registrationThis study is registered as PROSPERO CRD42016033879.FundingThe National Institute for Health Research Health Technology Assessment programme.

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