69 research outputs found
sj-docx-1-mdm-10.1177_0272989X221097106 – Supplemental material for Trends in Author-Reported Cost-Effectiveness Thresholds in the United States from 1995 to 2018: Implications for Discount Rates
No full textSupplemental material, sj-docx-1-mdm-10.1177_0272989X221097106 for Trends in Author-Reported Cost-Effectiveness Thresholds in the United States from 1995 to 2018: Implications for Discount Rates by Ankur Pandya, Mike Paulden, Jinyi Zhu, Tara A. Lavelle and James Hammitt in Medical Decision Making</p
Does Cost-Effectiveness Analysis Discriminate against Patients with Short Life Expectancy?
No full textDoes the use of quality-adjusted life-years (QALYs) in cost-effectiveness analyses (CEAs) of health care interventions necessarily discriminate against patients with short life expectancy compared with others? This paper reviews the arguments both that it does and that it does not, and demonstrates that whether the use of any time-dependent outcome measure in CEA will result in discrimination depends, in the context of any given choice between interventions, upon the choice of cost-effectiveness ‘threshold’ adopted by the decision maker, whether the incremental cost-effectiveness ratio (ICER) of the intervention for a subgroup of patients with relatively short life expectancy lies above the cost-effectiveness threshold, and whether the ICER for a subgroup of patients with longer life expectancy falls below the cost-effectiveness threshold. For discrimination to result against such patients requires that the long term ratio of costs to QALYs associated with the intervention be lower than the short term ratio of costs to QALYs. The implications for agencies which use CEA as part of their decision making are then discussed.
Does cost-effectiveness analysis discriminate against patients with short life expectancy? Matters of logic and matters of context
No full textThe aim of this paper is to explore the claim of ageism made against the National Institute for Health & Clinical Excellence and like organisations, and to identify circumstances under which ageist discrimination might arise. We adopt a broad definition of ageism as representing any discrimination against individuals or groups of individuals solely on the basis that they have shorter life expectancy than others. A simple model of NICE?s decision making process is developed which demonstrates that NICE?s recommendations do not inherently discriminate on the basis of life expectancy per se but that scope for discrimination may arise in the case of specific technologies having identifiable characteristics. Such discrimination may favour patients with either longer or shorter life expectancy. It is shown that NICE?s policies, procedures and the context in which NICE makes its decisions not only reduce the scope for discriminatory recommendations but also – in the case of “end of life” treatments – increase the likelihood that NICE?s recommendations favour those with shorter, rather than longer, life expectancy.
Budget allocation and the revealed social rate of time preference for health
No full textAppropriate decisions based on cost-effectiveness evaluations of health care technologies depend upon the cost-effectiveness threshold and its rate of growth as well as some social rate of time preference for health. The concept of the cost-effectiveness threshold, social rate of time preference for consumption and social opportunity cost of capital are briefly explored before the question of how a social rate of time preference for health might be established is addressed. A more traditional approach to this problem is outlined before a social decision making approach is developed which demonstrates that social time preference for health is revealed through the budget allocations made by a socially legitimate higher authority. The relationship between the social time preference rate for health, the growth rate of the cost-effectiveness threshold and the rate at which the higher authority can borrow or invest is then examined. We establish that the social time preference rate for health is implied by the budget allocation and the health production functions in each period. As such, the social time preference rate for health depends not on the social time preference rate for consumption or growth in the consumption value of health but on growth in the cost-effectiveness threshold and the rate at which the higher authority can save or borrow between periods. The implications for discounting and the policies of bodies such as NICE are then discussed.Economic evaluation. Discounting. Cost-effectiveness analysis
Recent amendments to NICE’s value-based assessment of health technologies: implicitly inequitable?
No full textClinical and Economic burden of Caesarean-section
No full textRising caesarean section (CS) rate remains a public health issue. Induction of labour (IOL) rates have been rising steadily in Canada from 12.9% in 1991 to 21.3% in 2004. Failed IOL occurs in 20% of induced pregnancies and is the major risk factor for CS. The purpose of this study was to investigate the impact of clinical and economic burden of CS. A rapid review of the literature was conducted to examine the risk factors for CS. Using data from the CHILD birth cohort, an emergency CS risk prediction tool was developed with six antennal factors: maternal age, height, BMI, pregnancy-induced hypertension, antenatal depression and birth order of the infant (area under the curve (AUC), 0.77 (0.71-0.82). This thesis also includes a retrospective cohort study of all singleton births in Alberta from 2005-2014 that evaluated the trends of CS, induction of labour (IOL), the association of IOL and CS, the impact of CS on childhood hospitalization or emergency department attendance with asthma or gastroenteritis. Understanding these associations will be beneficial in terms of offering the labour induction at appropriate gestation weeks in particular low-risk expectant mothers. Findings indicate that infants delivered by CS increased the healthcare service utilization by visiting emergency department with asthma and gastroenteritis than vaginally delivered infants. In addition, the results from the retrospective cohort demonstrated that IOL before reaching 39 weeks increased the risk of emergency CS when compared to expectant management. Moreover, IOL at 41 weeks is the most cost-effective strategy because it provides the most net health benefit (NHB) at a willingness-to-pay (WTP) threshold of $50,000 per QALY. This the first study conducting an economic evaluation of IOL at different gestation weeks in Canada. Implications of study results for clinicians and public health are discussed and future research directions are suggested
Incorporating equity in economic evaluations:a multi-attribute equity state approach
No full textIn publicly funded health care systems, decision makers must continually balance often conflicting priorities of efficiency and equity. Health economists have developed a set of highly sophisticated analytical methods for assessing efficiency, but less attention has been paid to formally incorporating equity considerations into analyses. As a result, where equity is considered is often informal, ad hoc and/or simplistic. This paper is a proposal for a mechanism for formally incorporating equity within the decision process. It begins with an overview of the current literature on equity weighting. It then considers the case of a single equity domain and illustrates how this is currently applied in practice by the UK’s National Institute for Health and Care Excellence. It then proposes a more comprehensive method for considering the multi-attribute equity state, where a population exhibits more than one trait considered worthy of differential weighting. Finally, the paper proposes a mechanism by which this could be applied in practice, and concludes with a discussion of the challenges for applying multi-attribute equity weighting.</p
Pitfalls of prioritizing cost-effectiveness in the assessment of medical innovation: A comment on Wallis and Detsky guest editorial
No full textTrends in Author-Reported Cost-Effectiveness Thresholds in the United States from 1995 to 2018: Implications for Discount Rates
No full textBackground: Decisions based on cost-effectiveness analyses (CEAs) using equal discount rates for health and cost outcomes are consistent with using a constant cost-effectiveness threshold over time. We sought to analyze trends in author-reported cost per quality-adjusted life-year (QALY) thresholds from CEAs published for the US setting over 24 y to retrospectively assess whether the recommended equal discount rates for costs and health were consistent with trends in the CEA literature.
Methods: We used the Tufts CEA Registry to assess whether author-reported cost-effectiveness thresholds changed in CEAs published for the US setting between 1995 and 2018 and back-calculated the implied discount rate for health based on these trends for inflation-adjusted cost-effectiveness thresholds and an annual discount rate for costs of 3%
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