Many countries are now considering the use of formal health economic methodologies to assess the value and prioritise health care interventions. However there is increasing recognition of the importance of values other than efficiency (cost effectiveness) in making acceptable decisions. This is manifest in the range of potential new approaches being developed including multiple criteria decision analysis.
Pavement rutting is a problem that has unknown consequences from a safety-based point of view. It is assumed that the wheelpath fills with water in wet-weather situations, thus increasing the potential for a vehicle to hydroplane. A study was conducted to quantify how pavement rutting affects accident rates and to evaluate possible safety-based guidelines for the treatment of pavement rutting. Rut depth, traffic volumes, and accident databases maintained by the Wisconsin Department of Transportation for undivided rural highways were then analyzed to identify statistical trends and relationships. Accidents were categorized as rut-related if the prevailing conditions could be potentially associated with the occurrence of hydroplaning. Rut depth measurements were average values for both directions of 1.8-km (1.1-mi) segments and represent the average elevation difference between the tire paths and the high point between them. The results of the statistical analyses indicated that the defined rut-related accident rate begins to increase at a significantly greater rate as rut depths exceed 7.6 mm (0.3 in.). The cost-effectiveness of potential accident reductions associated with reductions in the relative amount of rutted pavement was also evaluated.
Evidence generation and synthesis SECONDARY TRACK: Cost-effectiveness research BACKGROUND (INTRODUCTION): With health-care systems under increasing financial pressures, cost-effectiveness analysis is an area of increasing interest. The economic modeling of pathways of care and service configuration is not common, but potentially could offer significant and valuable information on the organization of health care. In association with National Collaborating Centres, the National Institute for Health and Clinical Excellence (NICE) produces guidelines on the appropriate treatment and care of people, which have included pathway modeling. We will explore the methods, opportunities, and challenges pathway modeling offers in clinical guidelines. LEARNING OBJECTIVES (TRAINING GOALS):1. Learn of methods to carry out cost-effectiveness analysis of clinical pathways. 2. Understand the challenges and opportunities of using more extensive cost-effectiveness analysis in guideline development. 3. Identify potential areas of future development for health economics in clinical guidelines. METHODS: A retrospective analysis of published NICE clinical guidelines, with the aim of identifying and extracting methodology applied to analyzing the cost-effectiveness of pathways of care and service configuration. We will examine how these analyses relate to the final recommendations. RESULTS: We will present a review of the methodologies utilized when modeling clinical pathways in NICE guidelines. We will examine how the methods chosen relate to the clinical questions under discussion. We will examine how decision makers interpreted these analyses and how they affected the formation of recommendations. We will present an outline of the challenges facing guideline developers when incorporating pathway modeling into their cost-effectiveness analysis. DISCUSSION (CONCLUSION): We will assess the appropriateness of the methodologies used and whether they had a significant impact on the decision-making process. We will examine the potential benefits and opportunities of modeling pathways of care. We will also discuss the potential challenges these methods pose to guideline developers in terms of skills and resourcing. Finally, we will consider what the future of pathway modeling is in clinical guidelines and how methods could develop.
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