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Economic evaluation of healthcare interventions: old and new directions

Published on Jan 1, 2016in Oxford Review of Economic Policy
· DOI :10.1093/oxrep/grv020
Alastair Gray73
Estimated H-index: 73
,
Thomas Wilkinson1
Estimated H-index: 1
Sources
Abstract
The techniques of economic evaluation have been increasingly widely applied in the health sector over recent decades, with hundreds of published evaluations performed in many countries and ranging across prevention programmes, diagnostics, treatment interventions, and the organization of health care. This paper examines the main methods in current use, and describes the gradual systematization of economic evaluation methodologies and the increasing importance of reimbursement agencies with explicit technical requirements. It reviews controversies in areas such as discounting, analytic perspective, identifying a cost-effectiveness threshold, differential treatment of particular disease areas or treatment groups, and the valuation of outcomes. It then considers in more detail the development of the World Health Organization’s generalized cost-effectiveness framework, and the emergence of an international ‘reference case’ commissioned by the Bill & Melinda Gates Foundation as a way of increasing the generalizability and comparability of such studies. Finally the paper discusses some current controversies and possible future developments in this field.
  • References (72)
  • Citations (8)
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References72
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#1Helen Dakin (University of Oxford)H-Index: 23
#2Nancy DevlinH-Index: 42
Last. David Parkin ('KCL': King's College London)H-Index: 32
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Background: The National Institute for Health and Care Excellence (NICE) emphasises that cost-effectiveness is not the only consideration in health technology appraisal and is increasingly explicit about other factors considered relevant. Observing NICE decisions and the evidence considered in each appraisal allows us to ‘reveal’ its implicit weights. Objectives: This study aims to investigate the influence of cost-effectiveness and other factors on NICE decisions and to investigate whether ...
100 CitationsSource
#1Benjarin Santatiwongchai (Health Intervention and Technology Assessment Program)H-Index: 3
#2Varit Chantarastapornchit (Health Intervention and Technology Assessment Program)H-Index: 3
Last. Yot Teerawattananon (Health Intervention and Technology Assessment Program)H-Index: 3
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Information generated from economic evaluation is increasingly being used to inform health resource allocation decisions globally, including in low- and middle- income countries. However, a crucial consideration for users of the information at a policy level, e.g. funding agencies, is whether the studies are comparable, provide sufficient detail to inform policy decision making, and incorporate inputs from data sources that are reliable and relevant to the context. This review was conducted to i...
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#1Scott D. Ramsey (UW: University of Washington)H-Index: 61
#2Richard J. Willke (Pfizer)H-Index: 26
Last. Sean D. Sullivan (UW: University of Washington)H-Index: 65
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Clinical trials evaluating medicines, medical devices, and procedures now commonly assess the economic value of these interventions. The growing number of prospective clinical/economic trials reflects both widespread interest in economic information for new technologies and the regulatory and reimbursement requirements of many countries that now consider evidence of economic value along with clinical efficacy. As decision makers increasingly demand evidence of economic value for health care inte...
172 CitationsSource
#1Mark Pennington (Lond: University of London)H-Index: 14
#2Richard Baker (GCU: Glasgow Caledonian University)H-Index: 54
Last. Cam Donaldson (GCU: Glasgow Caledonian University)H-Index: 60
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35 CitationsSource
#1Karl Claxton (Ebor: University of York)H-Index: 55
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Last. Mark Sculpher (Ebor: University of York)H-Index: 77
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A study by health economists at the University of York has, for the first time, produced an estimate of the impact on other NHS patients of new and more costly drugs and other treatments. This research suggests a refinement of the way the National Institute for Health and Clinical Excellence (NICE) gauges the cost-effectiveness of new interventions. It also has implications for the prices that the NHS can afford to pay for new drugs when the value-based pricing scheme for all new drugs is introd...
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#1Anthony J. CulyerH-Index: 41
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#1W Kipviscusi (Vandy: Vanderbilt University)H-Index: 69
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ABSTRACT This article estimates whether there is a cancer risk premium for the value of a statistical life using stated preference valuations of cancer risks for a large, nationally representative US sample. The present value of an expected cancer case that occurs after a one decade latency period is $10.85m, consistent with a cancer premium that is 21% greater than the median value of a statistical life estimates for acute fatalities. This cancer premium is smaller than the premium proposed for...
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#1Rachel Meacock (University of Manchester)H-Index: 9
#2Søren Rud Kristensen (University of Manchester)H-Index: 13
Last. Matt Sutton (University of Manchester)H-Index: 38
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Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider wh...
33 CitationsSource
#1David Canning (Harvard University)H-Index: 46
Cost-effectiveness analysis, which ranks projects by quality adjusted life years gained per dollar spent, is widely used in the evaluation of health interventions. We show that cost effectiveness analysis can be derived from two axioms: society prefers Pareto improvements and society values discounted life years, lived in perfect health, equally for each person. These axioms generate a unique social preference ordering, allowing us to find the cost effectiveness threshold to which health project...
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#1Warren G. Linley (Bangor University)H-Index: 3
#2Dyfrig A. Hughes (Bangor University)H-Index: 40
The criteria used by the National Institute for Health and Clinical Excellence (NICE) for accepting higher incremental cost-effectiveness ratios for some medicines over others, and the recent introduction of the Cancer Drugs Fund (CDF) in England, are assumed to reflect societal preferences for National Health Service resource allocation. Robust empirical evidence to this effect is lacking. To explore societal preferences for these and other criteria, including those proposed for rewarding new m...
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Sustaining HIV and AIDS responses depends on a mix of donor, government and private funders. Their decisions about investing in HIV treatment may be informed by various types of economic evaluation...
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#1Vimbayi Mutyambizi-Mafunda (UCT: University of Cape Town)H-Index: 1
#2Bronwyn Myers (South African Medical Research Council)H-Index: 28
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#1Joanna Emerson (Tufts Medical Center)H-Index: 1
#2Ari D. Panzer (Tufts Medical Center)H-Index: 2
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