scholarly journals Toward economic evaluation of the value of vaccines and other health technologies in addressing AMR

2018 ◽  
Vol 115 (51) ◽  
pp. 12911-12919 ◽  
Author(s):  
J. P. Sevilla ◽  
David E. Bloom ◽  
Daniel Cadarette ◽  
Mark Jit ◽  
Marc Lipsitch
Keyword(s):  
Economic Value ◽  
Decision Rules ◽  
Health Sector ◽  
Economic Evaluations ◽  
General Point ◽  
Value For Money ◽  
Mortality And Morbidity ◽  
Health Technologies ◽  
General Terms ◽  
Future Work

We discuss the need to make economic evaluations of vaccines antimicrobial resistance (AMR)-sensitive and ways to do so. Such AMR-sensitive evaluations can play a role in value-for-money comparisons of different vaccines within a national immunization program, or in comparisons of vaccine-centric and non-vaccine-centric technologies within an anti-AMR program. In general terms, incremental cost-effectiveness ratios and rates of return and their associated decision rules are unaltered by consideration of AMR-related value. The decision metrics need to have their various health, cost, and socioeconomic terms disaggregated into resistance-related subcategories, which in turn have to be measured carefully before they are reaggregated. The fundamental scientific challenges lie primarily in quantifying the causal impact of health technologies on resistance-related health outcomes, and secondarily in ascertaining the economic value of those outcomes. We emphasize the importance of evaluating vaccines in the context of other potentially complementary and substitutable nonvaccine technologies. Complementarity implies that optimal spending on each set of interventions is positive, and substitutability implies that the ratio of spending will depend on relative value for money. We exemplify this general point through a qualitative discussion of the complementarities and (especially the) substitutability between pneumococcal conjugate vaccines and antimicrobial stewardship and between research and development (R&D) of a gonorrhea vaccine versus R&D of a gonorrhea antibiotic. We propose a roadmap for future work, which includes quantifying the causal effects of vaccination and other health technologies on short-term and long-term resistance-related outcomes, measuring the health-sector costs and broader socioeconomic consequences of resistance-related mortality and morbidity, and evaluating vaccines in the context of nonvaccine complements and substitutes.

OP80 Reconciling Ethical And Economic Notions Of ‘Value’ For HTA

2018 ◽  
Vol 34 (S1) ◽  
pp. 29-30
Author(s):  
Mia Kibel ◽  
Meredith Vanstone
Keyword(s):  
Qualitative Content Analysis ◽  
Economic Value ◽  
Prenatal Testing ◽  
Policy Decision ◽  
Capabilities Approach ◽  
Future Research ◽  
Economic Evaluations ◽  
Health Technologies ◽  
Economic Framework ◽  
Ethical Evaluations

Introduction:Different disciplinary frameworks in the field of Health Technology Assessment (HTA) may hold different, and potentially contradictory, assumptions about a technology's value or optimal use. For example, economic analyses may be based on outcome measures that are socially controversial or ethically problematic. This can result in economic and ethical evaluations that are difficult to reconcile, leaving HTA short of its goal to provide policy decision-makers with a holistic assessment of technology. We use the case of non-invasive prenatal testing (NIPT) to explore whether the capabilities approach can be used to align economic and ethical concepts of value in assessments of morally challenging health technologies. The capabilities approach is an economic framework which bases wellbeing assessments on a person's abilities, rather than their expressed preferences.Methods:To develop concepts for capabilities relevant to NIPT, we started with Nussbaum's capabilities framework, and conducted a directed qualitative content analysis of interview data from twenty-seven Canadian women with personal experience of this technology.Results:We found that eight of Nussbaum's ten capabilities related to options or choices that women valued in the context of NIPT, and identified one new capability, Care Taking. NIPT has a meaningful impact on women's capabilities, and capabilities concepts can capture the value of NIPT without relying on health outcomes of ambiguous social and ethical value. A capabilities approach may help reconcile ethical and economic value frameworks for NIPT.Conclusions:The capabilities approach can contribute to economic evaluations of morally challenging health technologies that better reflect patient preferences and ethical concerns, and may contribute to more holistic HTAs. It provides a framework within which policy analysts from diverse disciplines can communicate about the social and ethical value of morally challenging health technologies. Future research should focus on operationalizing the capabilities approach for use in evaluations of NIPT and other morally challenging health technologies.

scholarly journals Health system modelling research: towards a whole-health-system perspective for identifying good value for money investments in health system strengthening

2019 ◽  
Vol 4 (2) ◽  
pp. e001311 ◽  
Author(s):  
Stéphane Verguet ◽  
Isabelle Feldhaus ◽  
Xiaoxiao Jiang Kwete ◽  
Anwer Aqil ◽  
Rifat Atun ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Health System ◽  
Health Sector ◽  
Health System Strengthening ◽  
Global Health Research ◽  
Economic Evaluations ◽  
System Modelling ◽  
Value For Money ◽  
Financial Risk Protection ◽  
System Perspective

Global health research has typically focused on single diseases, and most economic evaluation research to date has analysed technical health interventions to identify ‘best buys’. New approaches in the conduct of economic evaluations are needed to help policymakers in choosing what may be good value (ie, greater health, distribution of health, or financial risk protection) for money (ie, per budget expenditure) investments for health system strengthening (HSS) that tend to be programmatic. We posit that these economic evaluations of HSS interventions will require developing new analytic models of health systems which recognise the dynamic connections between the different components of the health system, characterise the type and interlinks of the system’s delivery platforms; and acknowledge the multiple constraints both within and outside the health sector which limit the system’s capacity to efficiently attain its objectives. We describe priority health system modelling research areas to conduct economic evaluation of HSS interventions and ultimately identify good value for money investments in HSS.

scholarly journals PENGGUNAAN INFORMASI FINANSIAL DALAM MENGUKUR KINERJA ORGANISASI SEKTOR PUBLIK (STUDI PADA PUSKESMAS BAHU)

2018 ◽  
Vol 13 (04) ◽  
Author(s):  
Brayel Topan Tambariki ◽  
Herman Karamoy ◽  
Steven J. Tangkuman
Keyword(s):  
Public Sector ◽  
Performance Measurement ◽  
Economic Efficiency ◽  
Qualitative Method ◽  
Health Sector ◽  
National Development ◽  
Financial Information ◽  
Value For Money ◽  
Budget Management ◽  
Public Sector Organizations

To succeed national development there are many aspects that must be considered. One of the most influential elements in national development is the budgetary. Budgetary issue is an important aspect, because it is one of the most vulnerable to fraud. Therefore, supervision of budget management should be held. In budgetary management, budget must fulfill three aspect of value for money, which are effectiveness, efficiency and economics. The State of Indonesia has many public sector organizations in various sectors. One of them is the organization in the health sector. Public sector organizations in the health sector are also important public sector organizations in national development, because they involve the interests of people's lives. In addition health is also one of the indicators in national development. Therefore, budget management in public sector organizations such as Puskesmas should be monitored for its performance, whether it is efficient, effective and economical. The purpose of this study is to determine the performance of Puskesmas Bahu based on the use of financial. This study used descriptive qualitative method. The results showed that financial information by measuring the level of economic, the level of efficiency and the level of effectiveness performance at the Puskesmas Bahu period 2014-2016 already fulfill the the aspect of value for money, which  economical, efficient and effective.Keywords : Performance Measurement, Value For Money, Economic, Efficiency, Effectiveness

scholarly journals Towards reducing variations in infant mortality and morbidity: a population-based approach

2016 ◽  
Vol 4 (1) ◽  
pp. 1-218 ◽  
Author(s):  
David Field ◽  
Elaine Boyle ◽  
Elizabeth Draper ◽  
Alun Evans ◽  
Samantha Johnson ◽  
...  
Keyword(s):  
Infant Mortality ◽  
Early Life ◽  
Developmental Outcomes ◽  
Research Programme ◽  
Mortality Rates ◽  
Population Based ◽  
Childhood Mortality ◽  
Mortality And Morbidity ◽  
Future Work

BackgroundOur aims were (1) to improve understanding of regional variation in early-life mortality rates and the UK’s poor performance in international comparisons; and (2) to identify the extent to which late and moderately preterm (LMPT) birth contributes to early childhood mortality and morbidity.ObjectiveTo undertake a programme of linked population-based research studies to work towards reducing variations in infant mortality and morbidity rates.DesignTwo interlinked streams: (1) a detailed analysis of national and regional data sets and (2) establishment of cohorts of LMPT babies and term-born control babies.SettingCohorts were drawn from the geographically defined areas of Leicestershire and Nottinghamshire, and analyses were carried out at the University of Leicester.Data sourcesFor stream 1, national data were obtained from four sources: the Office for National Statistics, NHS Numbers for Babies, Centre for Maternal and Child Enquiries and East Midlands and South Yorkshire Congenital Anomalies Register. For stream 2, prospective data were collected for 1130 LMPT babies and 1255 term-born control babies.Main outcome measuresDetailed analysis of stillbirth and early childhood mortality rates with a particular focus on factors leading to biased or unfair comparison; review of clinical, health economic and developmental outcomes over the first 2 years of life for LMPT and term-born babies.ResultsThe deprivation gap in neonatal mortality has widened over time, despite government efforts to reduce it. Stillbirth rates are twice as high in the most deprived as in the least deprived decile. Approximately 70% of all infant deaths are the result of either preterm birth or a major congenital abnormality, and these are heavily influenced by mothers’ exposure to deprivation. Births at < 24 weeks’ gestation constitute only 1% of all births, but account for 20% of infant mortality. Classification of birth status for these babies varies widely across England. Risk of LMPT birth is greatest in the most deprived groups within society. Compared with term-born peers, LMPT babies are at an increased risk of neonatal morbidity, neonatal unit admission and poorer long-term health and developmental outcomes. Cognitive and socioemotional development problems confer the greatest long-term burden, with the risk being amplified by socioeconomic factors. During the first 24 months of life each child born LMPT generates approximately £3500 of additional health and societal costs.ConclusionsHealth professionals should be cautious in reviewing unadjusted early-life mortality rates, particularly when these relate to individual trusts. When more sophisticated analysis is not possible, babies of < 24 weeks’ gestation should be excluded. Neonatal services should review the care they offer to babies born LMPT to ensure that it is appropriate to their needs. The risk of adverse outcome is low in LMPT children. However, the risk appears higher for some types of antenatal problems and when the mother is from a deprived background.Future workFuture work could include studies to improve our understanding of how deprivation increases the risk of mortality and morbidity in early life and investigation of longer-term outcomes and interventions in at-risk LMPT infants to improve future attainment.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Public–Private Partnerships in the health sector: the Danish experience

2008 ◽  
Vol 3 (2) ◽  
pp. 141-163 ◽  
Author(s):  
KARSTEN VRANGBÆK*
Keyword(s):  
Health Care ◽  
Large Scale ◽  
Health Sector ◽  
Theoretical Models ◽  
Public Private Partnerships ◽  
Public And Private ◽  
Theoretical Approaches ◽  
General Terms ◽  
Danish Health ◽  
Private And Public

AbstractThis article investigates the current use of Public–Private Partnerships (PPP) in the Danish health sector based on an initial discussion of theoretical approaches that analyze PPP. The empirical analysis concludes that PPP has been used very sparsely in the Danish health sector. There are few examples of large-scale partnership projects with joint investment and risk taking, but a number of smaller partnerships such as jointly owned companies at the regional level. When defining PPP more broadly, we can identify a long tradition for various types of collaboration between public and private actors in health care in Denmark. An analysis of the regulatory environment is offered as an explanation for the limited use of PPPs in Denmark. Major political and institutional actors at the central level differ in their enthusiasm for the PPP concept, and the regulatory framework is somewhat uncertain. A number of general issues and concerns related to PPPs are also discussed. It is suggested that a risk-based framework can be useful for mapping the potential and challenges for both private and public partners. Such a framework can be used to feed into game theoretical models of pros and cons for PPP projects. In general terms, it is concluded that more empirical research is needed for the assessment of the various risk factors involved in using PPPs in health care. Most PPPs are still very young, and the evidence on performance and broader governance issues is only just emerging. Ideally, such assessments should include comparisons with a purely public alternative.

scholarly journals Economic evaluation of intrahospital clinical practices in injury care: protocol for a 10-year systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e034472
Author(s):  
Blanchard Conombo ◽  
Jason Robert Guertin ◽  
Pier-Alexandre Tardif ◽  
Imen Farhat ◽  
Thomas Moore ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Incremental Cost ◽  
Economic Value ◽  
Health Benefit ◽  
Controlled Vocabulary ◽  
Acute Injury ◽  
Economic Evaluations ◽  
Clinical Practices ◽  
Care Protocol

IntroductionUnderuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. Injuries are second only to cardiovascular disease in terms of acute care costs but data on the economic impact of clinical practices for injury admissions are lacking. This study aims to summarise evidence on the economic value of intrahospital clinical practices for injury care.Methods and analysisWe will perform a systematic review to identify research articles in economic evaluation of intrahospital clinical practices in acute injury care. We will search MEDLINE and databases such as Embase, Web of Science, NHS Economic Evaluation Database, Cochrane CENTRAL, BIOSIS and CINAHL for randomised or non-randomised controlled trials and observational studies using a combination of keywords and controlled vocabulary. We will consider the following outcomes relative to economic evaluations: incremental cost-effectiveness ratio, incremental cost-utility ratio, incremental net health benefit, incremental net monetary benefit (iNMB) and incremental cost-benefit ratio. Pairs of independent reviewers will evaluate studies that meet eligibility criteria and extract data from included articles using an electronic data extraction form. All outcomes will be converted into iNMB. We will report iNMB for practices classified by type of practice (hospitalisation, consultation, diagnostic, therapeutic-surgical, therapeutic-drugs, therapeutic-other). Results obtained with a ceiling ratio of $50 000 per quality-adjusted life year gained for identified clinical practices will be summarised by charting forest plots. In line with Cochrane recommendations for systematic reviews of economic evaluations, meta-analyses will not be conducted.Ethics and disseminationEthics approval is not required as original data will not be collected. This study will summarise existing evidence on the economic value of clinical practices in injury care. Results will be used to advance knowledge on value-based care for injury admissions and will be disseminated through a peer-reviewed article, international scientific meetings and clinical and healthcare quality associations.

Economic guidelines for oncology products: Adaptation of the Canadian Agency for Drugs and Technologies in Health (CADTH) technology assessment guidance document

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17572-e17572
Author(s):  
N. Mittmann ◽  
W. K. Evans ◽  
A. Rocchi ◽  
C. J. Longo ◽  
H. J. Au ◽  
...  
Keyword(s):  
Working Group ◽  
Progression Free Survival ◽  
Target Population ◽  
Decision Makers ◽  
Phase Iii ◽  
Economic Evaluations ◽  
Guidance Document ◽  
Health Technologies ◽  
Intermediate Outcomes

e17572 Background: Economic evaluations (EE) are routinely used by decision-makers in Canada. CADTH's “Guidelines for the Economic Evaluation of Health Technologies: Canada” Third edition, 2006, provide guidance on the conduct of EEs for all therapeutic products. The consistency and quality of oncology EEs are variable and therapeutics in the cancer care environment presented unique challenges in decision making. Several chapters of the CADTH document adequately defined methods for the conduct of an oncology EE. However, some chapters required more specific guidance to improve the quality of oncology EEs. The goal was to provide direction on methods for the conduct of high quality EEs in oncology. Methods: The Working Group on Economic Analysis, NCIC CTG and CADTH jointly initiated this project and formed a working group (WG) of oncologists, health economists, decision makers and economic analysts. The WG identified CADTH chapters where oncology-specific guidance would be required. In-person and teleconference meetings provided content and structure for the document. Formal reviews by external academic experts, cancer agencies, patient groups and the pharmaceutical industry were conducted. Feedback was reviewed by the WG and incorporated as appropriate. Results: Chapters requiring guidance included: target population, comparators, perspective, effectiveness, modeling, type of evaluation, valuing health, time horizon, costs and resources, sensitivity analysis and equity. Guidance included clarity around CADTH methodology and recommendations for oncology products. For example for the effectiveness chapter, there was guidance around the use of intermediate outcomes (progression free survival vs. overall survival) and type of evidence (phase II vs. phase III). Overall recommendations for chapters will be presented. Conclusions: The oncology adapted economic guidelines provide specific guidance on the conduct of EEs for oncology products and will be published as an addendum to CADTH's third edition document. Their use should lead to more consistent application of EE methodologies for anti-cancer drugs and higher quality information for decision-makers at a national and perhaps international level. No significant financial relationships to disclose.

Issues in the Cross-National Assessment of Health Technology

1992 ◽  
Vol 8 (4) ◽  
pp. 670-682 ◽  
Author(s):  
Michael F. Drummond ◽  
Bernard S. Bloom ◽  
Guy Carrin ◽  
Alan L. Hillman ◽  
H. Christina Hutchings ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Health Technology ◽  
Economic Evaluations ◽  
Local Data ◽  
National Assessment ◽  
Health Technologies ◽  
National Differences ◽  
Rapid Spread ◽  
The Cost ◽  
Cross National

AbstractWith the growing international literature in economic evaluation and the rapid spread of new health technologies, there is a need to undertake, or at least interpret, economic evaluations on the international level. However, the ways in which cross-national differences affect the cost-effectiveness of health technologies or their evaluations have never been studied. This paper explores these issues by taking advantage of a unique situation in which the same economic evaluation of a new indication for a health technology was conducted simultaneously in four countries using an identical methodology. The study showed that if prior agreement on methods can be reached and local data applied, economic evaluations can be undertaken in a way that facilitates the extrapolation of results from country to country.

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