Bridging the Gap: Exploring the Barriers to Using Economic Evidence in Healthcare Decision Making and Strategies for Improving Uptake

Merlo, Gregory; Page, Katie; Ratcliffe, Julie; Halton, Kate; Graves, Nicholas

doi:10.1007/s40258-014-0132-7

Cited by 64 publications

(53 citation statements)

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“…13,18 Second, measuring costs related to hospital-acquired complications is inherently difficult; although we used conservative estimates to offset bias, it is important to note that variations, and challenges in costing may affect our findings. 33,34 Third, we were unable to directly account for unintended consequences related to our policy, including clinically appropriate changes from single-lumen to multilumen devices that not only may incur additional device and care costs, but also may expose patients to harm from PICC reinsertion. Because such aspects may adversely affect patient safety, use of the Michigan Appropriateness Guide to Intravenous Catheters to improve clinical decision-making and tailor PICC policies may prove helpful.…”

Section: Discussionmentioning

confidence: 99%

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Ratz

Hofer

Flanders

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND The number of peripherally inserted central catheter (PICC) lumens is associated with thrombotic and infectious complications. Because multilumen PICCs are not necessary in all patients, policies that limit their use may improve safety and cost. OBJECTIVE To design a simulation-based analysis to estimate outcomes and cost associated with a policy that encourages single-lumen PICC use. METHODS Model inputs, including risk of complications and costs associated with single- and multilumen PICCs, were obtained from available literature and a multihospital collaborative quality improvement project. Cost savings and reduction in central line-associated bloodstream infection and deep vein thrombosis events from institution of a single-lumen PICC default policy were reported. RESULTS According to our model, a hospital that places 1,000 PICCs per year (25% of which are single-lumen and 75% multilumen) experiences annual PICC-related maintenance and complication costs of $1,228,598 (95% CI, $1,053,175-$1,430,958). In such facilities, every 5% increase in single-lumen PICC use would prevent 0.5 PICC-related central line-associated bloodstream infections and 0.5 PICC-related deep vein thrombosis events, while saving $23,500. Moving from 25% to 50% single-lumen PICC utilization would result in total savings of $119,283 (95% CI, $74,030-$184,170) per year. Regardless of baseline prevalence, a single-lumen default PICC policy would be associated with approximately 10% cost savings. Findings remained robust in multiway sensitivity analyses. CONCLUSION Hospital policies that limit the number of PICC lumens may enhance patient safety and reduce healthcare costs. Studies measuring intended and unintended consequences of this approach, followed by rapid adoption, appear necessary. Infect Control Hosp Epidemiol 2016;37:811-817.

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Section: Discussionmentioning

confidence: 99%

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Ratz

Hofer

Flanders

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…Others have explored barriers to the use of economic evaluation by decision-makers 33 . A review by Merlo et al 33 used an accessibility and acceptability framework developed by Williams and Bryan 34 to categorise barriers to use of economic evaluations.…”

Section: Confidence In Changing Services Based On Current Evidencementioning

confidence: 99%

Section: Confidence In Changing Services Based On Current Evidencementioning

confidence: 99%

“…A review by Merlo et al 33 used an accessibility and acceptability framework developed by Williams and Bryan 34 to categorise barriers to use of economic evaluations. Accessibility refers to the ability of decision-makers to interpret and use economic evidence, and includes issues of complexity and timeliness of economic evaluations 33,34 . Acceptability includes factors associated with scientific rigor, applicability to the institution in which decisions are to be made, and ethical considerations such as equity 33,34 .…”

Section: Confidence In Changing Services Based On Current Evidencementioning

confidence: 99%

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A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

et al. 2018

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Cardiovascular disease remains the primary cause of death Background among Australians, despite dramatic improvements in overall cardiovascular health since the 1980s. Treating cardiovascular disease continues to place a significant economic strain on the Australian health care system, with direct healthcare costs exceeding those of any other disease. Coronary artery disease accounts for nearly one third of these costs and spending continues to rise. A range of treatments is available for coronary artery disease yet evidence of cost-effectiveness is missing, particularly for the Australian context. Cost-effectiveness evidence can signal waste and inefficiency and so is essential for an efficient allocation of healthcare resources.We used systematic review methods to search the literature across Methods: several electronic databases for economic evaluations of treatments for coronary artery disease. We critically appraised the literature found in searches, both against the CHEERS statement for quality reporting of economic evaluations and in terms of its usefulness for policy and decision-makers.We retrieved a total of 308 references, 229 once duplicates were Results: removed. Of these, 26 were excluded as they were not full papers (letters, editorials etc.), 55 were review papers, 50 were not cost-effectiveness analyses and 93 related to a highly specific patient sub-group or did not consider all treatment options. This left five papers to be reviewed in full.The current cost-effectiveness evidence does not support the Conclusions: increased use of PCI that has been seen in Australia and internationally. Due to problems with accessibility, clarity and relevance to policy and decision-makers, some otherwise very scientifically rigorous analyses have failed to generate any policy changes.

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“…However, there are barriers to evidence-based policy in these countries that include limited stakeholder awareness, resources and data availability [7, 8], as well as the lack of capacity to conduct country-specific economic evaluations [9]. Given the wide practice of using economic evidence to inform resource allocation in HICs, there are a number of studies that address these issues in these settings [10–12]. On the contrary, literature in LMICs is lacking despite the significant need.…”

Section: Introductionmentioning

confidence: 99%

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh

Teerawattananon

Tantivess

Yamabhai

et al. 2016

Health Res Policy Sys

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BackgroundEconomic evaluation has been implemented to inform policy in many areas, including coverage decisions, technology pricing, and the development of clinical practice guidelines. However, there are barriers to evidence-based policy in low- and middle-income countries (LMICs) that include limited stakeholder awareness, resources and data availability, as well as the lack of capacity to conduct country-specific economic evaluations. This study aims to survey health policy experts’ opinions on barriers to use of cost-effectiveness data in these settings and to obtain their advice on how to make a new cost-per-DALY database being developed by Tufts Medical Center more relevant to LMICs. It also identifies the factors influencing transferability.MethodsIn-depth interviews were conducted with 32 participants, including policymakers, technical advisors, and researchers in Health Ministries, universities and non-governmental organisations in Bangladesh, India (New Delhi, Tamil Nadu and Karnataka) and Vietnam.ResultsThe survey revealed that, in all settings, the use of cost-effectiveness information in policy development is lacking, owing to limited knowledge among policymakers and inadequate human resources with health economics expertise in the government sector. Furthermore, researchers in universities do not have close connections with health authorities. In India and Vietnam, the demand for evidence to inform coverage decisions tends to increase as the countries are moving towards universal health coverage. The informants in all countries argue that cost-effectiveness data are useful for decision-makers; however, most of them do not perform data searches by themselves but rely on the information provided by the technical advisor counterparts. Most interviewees were familiar with using evidence from other countries and were also aware of the influences of contextual elements as a limitation of transferability. Finally, strategies to promote the newly developed database include training on basic economic evaluation for policymakers and researchers, and effective communication programs, with support from reputable global agencies.ConclusionsAlthough cost-effectiveness information is recognised as essential in resource allocation, there are several impediments in the generation and use of such evidence to inform priority setting in LMICs. As such, the Cost-per-DALY database should be well-designed and introduced with appropriate promotion strategies so that it will be helpful in real-world policymaking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12961-016-0156-6) contains supplementary material, which is available to authorized users.

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Bridging the Gap: Exploring the Barriers to Using Economic Evidence in Healthcare Decision Making and Strategies for Improving Uptake

Cited by 64 publications

References 54 publications

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

A systematic review and critical analysis of cost-effectiveness studies for coronary artery disease treatment

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh

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