scholarly journals TRENDS AND OPPORTUNITIES IN HEALTH ECONOMIC EVALUATIONS OF PROSTHETIC CARE INNOVATIONS

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Laurent Frossard
Keyword(s):  
Health Economic ◽  
Collaborative Design ◽  
Health Economic Evaluation ◽  
Economic Benefits ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
Stage Of Development ◽  
Basic Framework ◽  
Substantial Economic Burden

Overcoming obstacles to prosthetic fittings requires frequent tryouts of sockets and components. Repetitions of interventions are upsetting for users and place substantial economic burden on healthcare systems. Encouraging prosthetic care innovations capable of alleviating clinical and financial shortcomings of socket-based solutions is essential. Nonetheless, evidence of socio-economic benefits of an innovation are required to facilitate access to markets. Unfortunately, complex decisions must be made when allocating resources toward the most relevant health economic evaluation (HEE) at a given stage of development of an innovation. This paper first, aimed to show the importance and challenges of HEEs of intervention facilitating prosthetic fittings. Next, the main trends in HEEs at various phases of product development and clinical acceptance of prosthetic care innovations were outlined. Then, opportunities for a basic framework of a preliminary cost-utility analysis (CUA) during the mid-stage of development of prosthetic care innovations were highlighted. To do this, fundamental and applied health economic literature and prosthetic-specific publications were reviewed to extract and analyse the trends in HEEs of new medical and prosthetic technologies, respectively. The findings show there is consensus around the weaknesses of full CUAs (e.g., lack of timeliness, resource-intensive) and strengths of preliminary CUAs (e.g., identify evidence gaps, educate design of full CUA, fast-track approval). However, several obstacles must be overcome before preliminary CUA of prosthetic care innovations will be routinely carried out. Disparities of methods and constructs of usual preliminary CUA are barriers that could be alleviated by a more standardized framework. The paper concludes by identifying that there are opportunities for the development of a basic framework of preliminary CUA of prosthetic care innovations. Ultimately, the collaborative design of a framework could simplify selection of the methods, standardise outcomes, ease comparisons between innovations and streamline pathways for adoption. This might facilitate access to economical solutions that could improve the life of individuals suffering from limb loss.   Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36364/28327 How To Cite: Frossard L. Trends and opportunities in health economic evaluations of prosthetic care innovations. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.9. https://doi.org/10.33137/cpoj.v4i2.36364 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: [email protected] number: https://orcid.org/0000-0002-0248-9589

scholarly journals Health economic measures in schizophrenia research

2007 ◽  
Vol 191 (S50) ◽  
pp. s42-s45 ◽  
Author(s):  
Paul McCrone
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
Cost Utility ◽  
Outcome Data ◽  
Cost Utility Analysis ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
Short Term ◽  
Effectiveness Analysis

BackgroundIt is essential in economic evaluations of schizophrenia interventions that all relevant costs are identified and measured appropriately Also of importance is the way in which cost data are combined with information on outcomesAimsTo examine the use of health economicsin evaluations of interventions for schizophreniaMethodsAreview of the key methods used to estimate costs and to link costs and outcomes was conductedResultsCosts fall on a number of different agencies and can be short term or long term. Cost-effectiveness analysis and cost-utility analysis are the most appropriate methods for combing cost and outcome dataConclusionsSchizophrenia poses a number of challenges for economic evaluation

Telestroke for acute ischaemic stroke: A systematic review of economic evaluations and a de novo cost–utility analysis for a middle income country

2021 ◽  
pp. 1357633X2110324
Author(s):  
Elise Tan ◽  
Lan Gao ◽  
Huong NQ Tran ◽  
Dominique Cadilhac ◽  
Chris Bladin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Rural China ◽  
Stroke Care ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Sensitivity Analyses ◽  
Economic Evaluations ◽  
Utility Analysis

Introduction Telemedicine can alleviate the problems faced in rural settings in providing access to specialist stroke care. The evidence of the cost-effectiveness of this model of care outside high-income countries is limited. This study aimed to conduct: (a) a systematic review of economic evaluations of telestroke and (b) a cost–utility analysis of telestroke, using China as a case study. Methods We systematically searched Embase, Medline Complete and Cochrane databases. Inclusion criteria: full economic evaluations of telemedicine/telestroke networks examining the use of thrombolysis in patients with acute ischaemic stroke, published in English. A cost–utility analysis was undertaken using a Markov model incorporating a decision tree to simulate the delivery of telestroke for acute ischaemic stroke in rural China, compared to no telestroke from a societal and healthcare perspective. One-way deterministic sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of results. Results Of 559 publications found, eight met the eligibility criteria and were included in the systematic review (two cost-effectiveness analyses and six cost–utility analyses, all performed in high-income countries). Telestroke was a cost-saving/cost-effective intervention in five out of the eight studies. In our modelled analysis for rural China, telestroke was the dominant strategy, with estimated cost savings of Chinese yuan 4,328 (US$627) and additional 0.0925 quality-adjusted life years per patient. Sensitivity analyses confirmed the base case results. Discussion Consistent with published economic evaluations of telestroke in other jurisdictions, telestroke represents a cost-effective solution to enhance stroke care in rural China.

scholarly journals Noncompliance and Missing Data in Health Economic Evaluation

2019 ◽  
Author(s):  
Karla DiazOrdaz ◽  
Richard Grieve
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
Missing Data ◽  
Causal Effect ◽  
Health Economic Evaluation ◽  
Specific Treatment ◽  
Model Specification ◽  
Sensitivity Analyses ◽  
Economic Evaluations ◽  
Random Assignment

Health economic evaluations face the issues of noncompliance and missing data. Here, noncompliance is defined as non-adherence to a specific treatment, and occurs within randomized controlled trials (RCTs) when participants depart from their random assignment. Missing data arises if, for example, there is loss-to-follow-up, survey non-response, or the information available from routine data sources is incomplete. Appropriate statistical methods for handling noncompliance and missing data have been developed, but they have rarely been applied in health economics studies. Here, we illustrate the issues and outline some of the appropriate methods with which to handle these with application to health economic evaluation that uses data from an RCT. In an RCT the random assignment can be used as an instrument-for-treatment receipt, to obtain consistent estimates of the complier average causal effect, provided the underlying assumptions are met. Instrumental variable methods can accommodate essential features of the health economic context such as the correlation between individuals’ costs and outcomes in cost-effectiveness studies. Methodological guidance for handling missing data encourages approaches such as multiple imputation or inverse probability weighting, which assume the data are Missing At Random, but also sensitivity analyses that recognize the data may be missing according to the true, unobserved values, that is, Missing Not at Random. Future studies should subject the assumptions behind methods for handling noncompliance and missing data to thorough sensitivity analyses. Modern machine-learning methods can help reduce reliance on correct model specification. Further research is required to develop flexible methods for handling more complex forms of noncompliance and missing data.

scholarly journals Microsimulation model for the health economic evaluation of osteoporosis interventions: study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e028365
Author(s):  
Lei Si ◽  
John A Eisman ◽  
Tania Winzenberg ◽  
Kerrie M Sanders ◽  
Jacqueline R Center ◽  
...  
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
User Interface ◽  
Economic Model ◽  
Health Economic Evaluation ◽  
Economic Models ◽  
Economic Evaluations ◽  
Microsimulation Model ◽  
Study Results ◽  
Health Economic Model

IntroductionOsteoporosis is a systemic skeletal disease that is characterised by reduced bone strength and increased fracture risk. Osteoporosis-related fractures impose enormous disease and economic burden to the society. Although many treatments and health interventions are proven effective to prevent fractures, health economic evaluation adds evidence to their economic merits. Computer simulation modelling is a useful approach to extrapolate clinical and economic outcomes from clinical trials and it is increasingly used in health economic evaluation. Many osteoporosis health economic models have been developed in the past decades; however, they are limited to academic use and there are no publicly accessible health economic models of osteoporosis.Methods and analysisWe will develop the Australian osteoporosis health economic model based on our previously published microsimulation model of osteoporosis in the Chinese population. The development of the model will follow the recommendations for the conduct of economic evaluations in osteoporosis by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the US branch of the International Osteoporosis Foundation. The model will be a state-transition semi-Markov model with memory. Clinical parameters in the model will be mainly obtained from the Dubbo Osteoporosis Epidemiology Study and the health economic parameters will be collected from the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study. Model transparency and validates will be tested using the recommendations from Good Research Practices in Modelling Task Forces. The model will be used in economic evaluations of osteoporosis interventions including pharmaceutical treatments and primary care interventions. A user-friendly graphical user interface will be developed, which will connect the user to the calculation engine and the results will be generated. The user interface will facilitate the use of our model by people in different sectors.Ethics and disseminationNo ethical approval is needed for this study. Results of the model validation and future economic evaluation studies will be submitted to journals. The user interface of the health economic model will be publicly available online accompanied with a user manual.

Health economic evaluation in ophthalmology

2020 ◽  
pp. bjophthalmol-2020-316880
Author(s):  
Alp Atik ◽  
Keith Barton ◽  
Augusto Azuara-Blanco ◽  
Nathan M Kerr
Keyword(s):  
Health Economic ◽  
Economic Evaluation ◽  
Clinical Decision Making ◽  
Health Economic Evaluation ◽  
Cost Benefit ◽  
Clinical Decision ◽  
Cost Utility ◽  
Economic Modelling ◽  
Increasing Demand ◽  
Healthcare Interventions

Health economic evaluation is the application of economic theories, tools and concepts to healthcare. In the setting of limited resources, increasing demand and a growing array of intervention options, economic evaluation provides a framework for measuring, valuing and comparing the costs and benefits of different healthcare interventions. This review provides an overview of the concepts and methods of economic evaluation, illustrated with examples in ophthalmology. Types of economic evaluation include cost-minimisation, cost-benefit, cost-effectiveness, cost-utility and economic modelling. Topics including utility measures, the quality-adjusted lifeyear, discounting, perspective and timeframe are discussed. Health economic evaluation is important to understand the costs and value of interventions in ophthalmology and to inform health policy as well as guide clinical decision-making.

scholarly journals Economic Evaluations in the Canadian Mental Health System I: Theory behind Economic Evaluation*

1989 ◽  
Vol 34 (7) ◽  
pp. 633-636 ◽  
Author(s):  
Bruce J. Fried ◽  
Catherine Worthington ◽  
Raisa B. Deber
Keyword(s):  
Mental Health ◽  
Economic Evaluation ◽  
Health Program ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
Mental Health Programs

Economic evaluation is becoming an increasingly important part of the evaluation of health and mental health services. Current models for conducting economic evaluation, including cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis, have great potential for improving the quality of decision-making and for making mental health programs more effective and efficient. This paper presents the basic economic theory underlying the various forms of economic evaluation and provides general guidelines for developing and conducting an economic analysis of a health program.

scholarly journals Pharmacy-based screening to detect persons at elevated risk of type 2 diabetes: a cost-utility analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kari Jalkanen ◽  
Emma Aarnio ◽  
Piia Lavikainen ◽  
Jaana Lindström ◽  
Markku Peltonen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Cost Utility ◽  
Elevated Risk ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Payback Time ◽  
Base Scenario

Abstract Background Early identification of people at elevated risk of type 2 diabetes (T2D) is an important step in preventing or delaying its onset. Pharmacies can serve as a significant channel to reach these people. This study aimed to assess the potential health economic impact of screening and recruitment services in pharmacies in referring people to preventive interventions. Methods A decision analytic model was constructed to perform a cost-utility analysis of the expected national health economic consequences (in terms of costs and quality-adjusted life years, QALYs) of a hypothetical pharmacy-based service where people screened and recruited through pharmacies would participate in a digital lifestyle program. Cost-effectiveness was considered in terms of net monetary benefit (NMB). In addition, social return on investment (SROI) was calculated as the ratio of the intervention and recruitment costs and the net present value of expected savings. Payback time was the time taken to reach the break-even point in savings. In the base scenario, a 20-year time horizon was applied. Probabilistic and deterministic sensitivity analyses were applied to study robustness of the results. Results In the base scenario, the expected savings from the pharmacy-based screening and recruitment among the reached target cohort were 255.3 m€ (95% CI − 185.2 m€ to 717.2 m€) in pharmacy visiting population meaning 1412€ (95% CI − 1024€ to 3967€) expected savings per person. Additionally, 7032 QALYs (95% CI − 1344 to 16,143) were gained on the population level. The intervention had an NMB of 3358€ (95% CI − 1397€ to 8431€) using a cost-effectiveness threshold of 50,000 €/QALY. The initial costs were 122.2 m€ with an SROI of 2.09€ (95% CI − 1.52€ to 5.88€). The expected payback time was 10 and 8 years for women and men, respectively. Results were most sensitive for changes in effectiveness of the intervention and selected discount rate. Conclusions T2D screening and recruitment to prevention programs conducted via pharmacies was a dominant option providing both cost savings and QALY gains. The highest savings can be potentially reached by targeting recruitment at men at elevated risk of T2D.

Optimising health economic evaluations for geriatric cancer patients

2017 ◽  
Vol 23 (03) ◽  
pp. 123-128
Author(s):  
Andrea Goettler ◽  
Tanja-Maria Kessel ◽  
Diana Sonntag
Keyword(s):  
Health Economic ◽  
Elderly Patients ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Geriatric Patients ◽  
The Elderly ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Cost Calculation ◽  
Geriatric Cancer

Abstract Aim Despite the growing number of elderly cancer patients, health economic evaluations have not put enough attention on this patient group. We reflect on the current state of health economic evaluations for geriatric patients and present suggestions for improvements. Method We reviewed the scientific literature on health economic evaluations for geriatric patients in Germany and internationally. Additionally, we conducted a scoping review on cost-utility analyses on cancer treatment for older patients (> 60 years). Results The literature review resulted in eight relevant studies. Besides the paucity of economic evaluations for elderly patients, we also present quality limitations. From the literature, we identify four recommendations regarding cost calculation, geriatric assessment, patient decision-making and quality of life on how to design better economic evaluations for geriatric cancer treatment. Conclusion The demographic change requires more attention regarding elderly patients in health economics. Including patients above 70 years of age in health economic evaluations and improving cost-utility analyses will help to improve resource allocations and effective healthcare for the elderly.

Quality of economic evaluations of ventricular assist devices: A systematic review

2020 ◽  
Vol 36 (4) ◽  
pp. 380-387
Author(s):  
Sarah Fontenay ◽  
Lionel Catarino ◽  
Soumeya Snoussi ◽  
Hélène van den Brink ◽  
Judith Pineau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Economic ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Economic Evaluation ◽  
Ventricular Assist Devices ◽  
Economic Evaluations ◽  
Level Of Evidence ◽  
Ventricular Assist

ObjectiveBecause of a lack of suitable heart donors, alternatives to transplantation are required. These alternatives can have high costs. The aim of this study was to perform a systematic review of cost-effectiveness studies of ventricular assist devices (VADs) and to assess the level of evidence of relevant studies. The purpose was not to present economic findings.MethodsA systematic review was performed using four electronic databases to identify health economic evaluation studies dealing with VADs. The methodological quality and reporting quality of the studies was assessed using three different tools, the Drummond, Cooper, and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklists.ResultsOf the 1,258 publications identified, thirteen articles were included in this review. Twelve studies were cost–utility analyses and one was a cost-effectiveness analysis. According to the Cooper hierarchy scale, the quality of the data used was heterogeneous. The level of evidence used for clinical effect sizes, safety data, and baseline clinical data was of poor quality. In contrast, cost data were of high quality in most studies. Quality of reporting varied between studies, with an average score of 17.4 (range 15–19) according to the CHEERS checklist.ConclusionThe current study shows that the quality of clinical data used in economic evaluations of VADs is rather poor in general. This is a concern that deserves greater attention in the process of health technology assessment of medical devices.

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