Efficacy and cost-effectiveness of behavioral interventions in nonclinical settings for improving health outcomes.

2019 ◽  
Vol 38 (8) ◽  
pp. 689-700 ◽  
Author(s):  
Dawn K. Wilson ◽  
Kate Lorig ◽  
William M. P. Klein ◽  
William Riley ◽  
Allison M. Sweeney ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Behavioral Interventions

Are Discount Rates Too High? Population Health and Intergenerational Equity

2021 ◽  
Vol 41 (2) ◽  
pp. 245-249
Author(s):  
R. Scott Braithwaite ◽  
Mark S. Roberts
Keyword(s):  
Health Policy ◽  
Cost Effectiveness ◽  
Decision Theory ◽  
Health Outcomes ◽  
Societal Perspective ◽  
Environmental Damage ◽  
Healthy Population ◽  
Discount Rates ◽  
Policy Decisions ◽  
Effectiveness Analysis

Increasing attention is being paid to policy decisions in which shorter-term benefits may be eclipsed by longer-term harms, such as environmental damage. Health policy decisions have largely been spared this scrutiny, even though they too may contribute to longer-term harms. Any healthy population or society must sustain itself through reproduction, and therefore, transgenerational outcomes should be of intrinsic importance from a societal perspective. Yet, the discount rates typically employed in cost-effectiveness analyses have the effect of minimizing the importance of transgenerational health outcomes. We argue that, because cost-effectiveness analysis is based on foundational axioms of decision theory, it should value transgenerational outcomes consistently with those axioms, which require discount rates substantially lower than 3%. We discuss why such lower rates may not violate the Cretin-Keeler paradox.

scholarly journals Keeping PACE With 21st Century Healthcare: A Framework for Telehealth Research, Practice, and Program Evaluation in Occupational Therapy

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Lauren M. Little ◽  
Kristen A. Pickett ◽  
Rachel Proffitt ◽  
Jana Cason
Keyword(s):  
Program Evaluation ◽  
Cost Effectiveness ◽  
Occupational Therapy ◽  
Health Outcomes ◽  
21St Century ◽  
Outcome Measure ◽  
Research Practice ◽  
Future Directions ◽  
Telehealth Service ◽  
Therapy Services

The use of telehealth to deliver occupational therapy services rapidly expanded during the COVID-19 pandemic. There are frameworks to evaluate services delivered through telehealth; however, none are specific to occupational therapy. Therefore, occupational therapy would benefit from a framework to systematically evaluate components of telehealth service delivery and build evidence to demonstrate the distinct value of occupational therapy.  The PACE Framework outlines four priority domains to address areas of need: (1) Population and Health Outcomes; (2) Access for All Clients; (3) Costs and Cost Effectiveness; and (4) Experiences of Clients and Occupational Therapy Practitioners. This article describes the development and expert reviewer evaluation of the PACE Framework. In addition, the PACE Framework’s domains, subdomains, and outcome measure examples are described along with future directions for implementation in occupational therapy research, practice, and program evaluation. 

scholarly journals Pharmacist prescribing and care improves cardiovascular risk, but is it cost-effective? A cost-effectiveness analysis of the RxEACH study

2019 ◽  
Vol 152 (4) ◽  
pp. 257-266 ◽  
Author(s):  
Yazid N. Al Hamarneh ◽  
Karissa Johnston ◽  
Carlo A. Marra ◽  
Ross T. Tsuyuki
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Usual Care ◽  
Population Level ◽  
Cost Effective ◽  
Pharmacist Intervention ◽  
Sensitivity Analyses ◽  
Pharmacist Prescribing ◽  
Canadian Health Care System ◽  
Life Years

Background: The RxEACH randomized trial demonstrated that community pharmacist prescribing and care reduced the risk for cardiovascular (CV) events by 21% compared to usual care. Objective: To evaluate the economic impact of pharmacist prescribing and care for CV risk reduction in a Canadian setting. Methods: A Markov cost-effectiveness model was developed to extrapolate potential differences in long-term CV outcomes, using different risk assessment equations. The mean change in CV risk for the 2 groups of RxEACH was extrapolated over 30 years, with costs and health outcomes discounted at 1.5% per year. The model incorporated health outcomes, costs and quality of life to estimate overall cost-effectiveness. It was assumed that the intervention would be 50% effective after 10 years. Individual-level results were scaled up to population level based on published statistics (29.2% of Canadian adults are at high risk for CV events). Costs considered included direct medical costs as well as the costs associated with implementing the pharmacist intervention. Uncertainty was explored via probabilistic sensitivity analysis. Results: It is estimated that the Canadian health care system would save more than $4.4 billion over 30 years if the pharmacist intervention were delivered to 15% of the eligible population. Pharmacist care would be associated with a gain of 576,689 quality-adjusted life years and avoid more than 8.9 million CV events. The intervention is economically dominant (i.e., it is both more effective and reduces costs when compared to usual care). Conclusion: Across a range of 1-way and probabilistic sensitivity analyses of key parameters and assumptions, pharmacist prescribing and care are both more effective and cost-saving compared to usual care. Canadians need and deserve such care.

scholarly journals Health outcomes and cost-effectiveness of diversion programs for low-level drug offenders: A model-based analysis

PLoS Medicine ◽  
2020 ◽  
Vol 17 (10) ◽  
pp. e1003239 ◽  
Author(s):  
Cora L. Bernard ◽  
Isabelle J. Rao ◽  
Konner K. Robison ◽  
Margaret L. Brandeau
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Diversion Programs ◽  
Drug Offenders ◽  
Low Level ◽  
Model Based ◽  
Model Based Analysis

Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?

2018 ◽  
Vol 21 (4) ◽  
pp. 120-139 ◽  
Author(s):  
Marta Marino ◽  
Antonio G de Belvis ◽  
Maria Tanzariello ◽  
Emanuele Dotti ◽  
Sabina Bucci ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Integrated Care ◽  
Service Providers ◽  
Systems Of Care ◽  
Social Needs ◽  
Narrative Review ◽  
A Value ◽  
Care Models ◽  
Integrated Care Models

Introduction The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly ≥65 years old, with complex health and social needs, not disease-specific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.

Cost-effectiveness of treating head and neck cancer using intensity-modulated radiation therapy: implications for cancer control program in India

2020 ◽  
Vol 36 (5) ◽  
pp. 492-499
Author(s):  
Akashdeep Singh Chauhan ◽  
Shankar Prinja ◽  
Sushmita Ghoshal ◽  
Roshan Verma
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Incremental Cost ◽  
Head And Neck ◽  
Tertiary Care ◽  
Primary Data ◽  
Costs And Benefits ◽  
Intensity Modulated ◽  
The Cost ◽  
3D Crt

BackgroundThe newer cancer treatment technologies hold the potential of providing improved health outcomes at an additional cost. So it becomes obligatory to assess the costs and benefits of a new technology, before defining its clinical value. We assessed the cost-effectiveness of intensity-modulated radiotherapy (IMRT) as compared to 2-dimensional radiotherapy (2-DRT) and 3-dimensional radiotherapy (3D-CRT) for treating head and neck cancers (HNC) in India. The cost-effectiveness of 3-DCRT as compared to 2-DRT was also estimated.MethodsA probabilistic Markov model was designed. Using a disaggregated societal perspective, lifetime study horizon and 3 percent discount rate, future costs and health outcomes were compared for a cohort of 1000 patients treated with any of the three radiation techniques. Data on health system cost, out of pocket expenditure, and quality of life was assessed through primary data collected from a large tertiary care public sector hospital in India. Data on xerostomia rates following each of the radiation techniques was extracted from the existing randomized controlled trials.ResultsIMRT incurs an incremental cost of $7,072 (2,932–13,258) and $5,164 (463–10,954) per quality-adjusted life year (QALY) gained compared to 2-DRT and 3D-CRT, respectively. Further, 3D-CRT as compared to 2-DRT requires an incremental cost of $8,946 (1,996–19,313) per QALY gained.ConclusionBoth IMRT and 3D-CRT are not cost-effective at 1 times GDP per capita for treating HNC in India. The costs and benefits of using IMRT for other potential indications (e.g. prostate, lung) require to be assessed before considering its introduction in India.

Cost-effectiveness analysis of magnetic resonance imaging-ultrasound fusion biopsy versus systematic transrectal ultrasound-guided biopsy in diagnosing prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 25-25 ◽  
Author(s):  
Matthew Ingham ◽  
Matthew Mossanen ◽  
Ye Wang ◽  
Steven Lee Chang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Health Outcomes ◽  
Transrectal Ultrasound ◽  
Sensitivity Analyses ◽  
Resonance Imaging ◽  
Ultrasound Guided ◽  
Fusion Biopsy

25 Background: We sought to determine if the reported improved performance of magnetic resonance imaging-ultrasound (MRI-US) fusion biopsy over systematic transrectal ultrasound-guided biopsy (TRUS) in the detection of prostate cancer justifies the added cost of the MR imaging. Methods: A decision-analytic Markov model with a lifetime horizon of 10 years was developed to evaluate diagnostic accuracy, long-term health outcomes, costs, and quality-of-life of two strategies (i.e., TRUS versus MRI-US fusion biopsy [prostate MRI followed potentially by MRI-US fusion biopsy]) as the initial diagnostic test in men with elevated prostate-specific antigen ( > 4 ng/ml) without prior evaluation. Probabilities of clinical events were obtained from published literature. Direct medical costs, including diagnostic and treatment-related costs, were derived from the Premier Hospital Database. Costs were inflated to 2015 US dollars and discounted at an annual rate of 3%. Health outcomes were measured in quality-adjusted life years (QALYs), which were determined based on published literature and expert opinion. We calculated the incremental cost-effectiveness ratio and performed sensitivity analyses to assess uncertainty. Results: The MRI-US fusion biopsy strategy yielded a lower average discounted cost ($5,358 versus $6,372) and higher total QALYs-gained (7.21 versus 7.19) than TRUS. The reduced expenditures associated with MRI-US fusion biopsy was primarily due to avoiding intervention for clinically insignificant prostate cancer. The results were robust with the sensitivity analyses. Conclusions: For men in the United States with an elevated PSA, the use of MRI-US fusion biopsy in the evaluation for prostate cancer represents a greater value than TRUS, the standard of care option. Widespread adoption of MRI-US fusion biopsy may serve to reduce the economic burden of prostate cancer.

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