1,721,147 research outputs found
The valuation of NHS hospitals under capital charging
No full textCapital charging occurs when public or quasi-public providers of public services must explicitly pay for their capital through the mechanism of an annual charge based upon the value of assets used in service provision. The rationale is that no longer treating capital as a 'free good' will lead to improvements in productive efficiency. Attempts to make public sector financial management more closely approximate private sector models inevitably encounter the twin problems of measuring public sector output and valuing public sector capital. For asset valuation, use has been made in the National Health Service (NHS) of depreciated replacement cost (DRC), making the assumption that existing assets will be replaced on a like-for-like basis, rather than valuing with reference to the modern equivalent asset. Four interrelated technical problems with DRC in the NHS are distinguished, all suggesting overvaluation: it cannot safely be assumed that a building is worth the sum of its component parts; hospitals consist of different vintages of buildings, of markedly different suitabilities for current healthcare provision; the configuration of buildings on particular sites can dramatically affect rationalization possibilities; and there are profound difficulties within the DRC framework of determining what constitutes capital expenditure. Further complications arise from the fact that a growing proportion of hospital buildings is architecturally listed, and from the new policy commitment to expand the role of privately financed assets (which fall outside the capital charging system)
Reimbursement and value‐based pricing: stratified cost‐effectiveness analysis may not be the last word
No full textDuring recent discussions, it has been argued that stratified cost-effectiveness analysis has a key role in reimbursement decision‐making and value‐based pricing (VBP). It has previously been shown that when manufacturers are price‐takers, reimbursement decisions made in reference to stratified cost‐effectiveness analysis lead to a more efficient allocation of resources than decisions based on whole‐population cost‐effectiveness analysis. However, we demonstrate that when manufacturers are price setters, reimbursement or VBP based on stratified cost‐effectiveness analysis may not be optimal. Using two examples – one considering the choice of thrombolytic treatment for specific patient subgroups and the other considering the extension of coverage for a cancer treatment to include an additional indication – we show that combinations of extended coverage and reduced price can be identified that are advantageous to both payers and manufacturers. The benefits of a given extension in coverage and reduction in price depend both upon the average treatment benefit in the additional population and its size relative to the original population. Negotiation regarding trade‐offs between price and coverage may lead to improved outcomes both for health‐care systems and manufacturers compared with processes where coverage is determined conditional simply on stratified cost‐effectiveness at a given price. Copyright (C) 2010 John Wiley & Sons, Ltd.value‐based pricing , stratified cost‐effectiveness analysis ,
Letter in response to: Cooper et al. Established search filters may miss studies when identifying randomized controlled trials [J Clin Epidemiol. 2019 Apr 13;112:12-19. doi: 10.1016/j.jclinepi.2019.04.002]. Language for trial phase necessary when searching for RCT
No full textResponse to Comments on “No Study Left Behind: A Network Meta-Analysis in Non–Small-Cell Lung Cancer Demonstrating the Importance of Considering All Relevant Data”
No full textHow far do you go? Efficient searching for indirect evidence.
No full textBACKGROUND: Indirect evidence is particularly valuable in health care decision making when direct trial evidence comparing relevant treatments is absent or limited. Current approaches using a predetermined set of comparators in the search query may fail to identify all relevant indirect evidence. PURPOSE: To present a framework for the efficient design of search strategies for identifying clinical trials providing indirect evidence for a treatment comparison. FINDINGS: The authors present 2 search strategies that differ from traditional search strategies in using a series of iterative searches to identify the set of relevant comparators. In both, the comparators included in each search are determined by the results of previous searches. For a given number of searches, the strategies presented will find all indirect comparisons that include a certain number of comparators linking the treatments of interest. Methods of estimating the value of indirect evidence via a given number of comparators linking the treatments of interest are presented, thus allowing the burden of additional searching to be traded off against the likely impact of finding more distant comparisons. A practical illustration of the search strategies in the context of informing a network meta-analysis of second-line treatments for non-small cell lung cancer is presented. CONCLUSIONS: The iterative strategies presented offer a means of identifying such evidence and allow the researcher to determine the optimal scope of the search by estimating the value of additional indirect evidence
Valuing health care using willingness to pay: a comparison of the payment card and dichotomous choice methods
No full textThis paper compares willingness to pay (WTP) estimates generated from the dichotomous choice (DC) and payment card (PC) approaches. In a split-sample WTP experiment concerned with allocating scarce health care resources across three health care interventions, the DC approach is shown consistently to generate larger welfare estimates than the PC. Observed difference between PC and DC experiments cannot be explained by the inclusion of non-demanders or methods of statistical analysis but may be partly explained by "yea-saying". No evidence of range bias or mid-point bias was found with PC responses. Data were also collected on respondents' ordinal rankings of the three interventions and person-trade-offs (PTOs). Neither of these approaches converged with WTP. Future work must address the decision heuristics individuals employ when responding to valuation experiments.</p
No study left behind: a network meta-analysis in non-small-cell lung cancer demonstrating the importance of considering all relevant data.
No full textOBJECTIVE: To demonstrate the importance of considering all relevant indirect data in a network meta-analysis of treatments for non-small-cell lung cancer (NSCLC). METHODS: A recent National Institute for Health and Clinical Excellence appraisal focussed on the indirect comparison of docetaxel with erlotinib in second-line treatment of NSCLC based on trials including a common comparator. We compared the results of this analysis to a network meta-analysis including other trials that formed a network of evidence. We also examined the importance of allowing for the correlations between the estimated treatment effects that can arise when analysing such networks. RESULTS: The analysis of the restricted network including only trials of docetaxel and erlotinib linked via the common placebo comparator produced an estimated mean hazard ratio (HR) for erlotinib compared with docetaxel of 1.55 (95% confidence interval [CI] 0.72-2.97). In contrast, the network meta-analysis produced an estimated HR for erlotinib compared with docetaxel of 0.83 (95% CI 0.65-1.06). Analyzing the wider network improved the precision of estimated treatment effects, altered their rankings and also allowed further treatments to be compared. Some of the estimated treatment effects from the wider network were highly correlated. CONCLUSIONS: This empirical example shows the importance of considering all potentially relevant data when comparing treatments. Care should therefore be taken to consider all relevant information, including correlations induced by the network of trial data, when comparing treatments
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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