Conceptualising ‘Benefits Beyond Health’ in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis

Engel, Lidia; Bryan, Stirling; Whitehurst, David G. T.

doi:10.1007/s40273-021-01074-x

Cited by 6 publications

(6 citation statements)

References 144 publications

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“…A second extension considered in this paper is specifically related to extending the outcomes associated with health interventions [15]. It is widely recognised that health, commonly quantified using QALYs, does not encompass all the outcomes that are relevant for decision making.…”

Section: Extensions To the Single-sector Unidimensional Cea Frameworkmentioning

confidence: 99%

The Broader Opportunity Costs in the Broader Cost-Effectiveness Analysis Framework

Vallejo-Torres

2023

Appl Health Econ Health Policy

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Background The traditional cost-effectiveness analysis framework usually takes a healthcare system perspective, where the aim is to maximise population health from a fixed budget allocated to healthcare. Extensions to this framework have been suggested, including: (i) incorporating impacts that fall outside the healthcare sector; (ii) accounting for outcomes beyond health; and (iii) assessing equity considerations. Several alternatives have been proposed that serve these purposes, for example, the extended "impact inventory", the "beyond-the-QALY" approach and the distributional cost-effectiveness analysis. Objective This paper aims to develop a comprehensive framework that incorporates into the cost-effectiveness analysis framework some of its most advocated extensions and provides a means of arriving at a unidimensional cost-effectiveness analysis result measure. Methods Building on previous work, I proposed a framework that explicitly incorporates the full extent of the opportunity costs that arise when new dimensions and distributional concerns are included in cost-effectiveness analyses. A hypothetical example is provided as a way of illustration. Results Operationalising the proposed framework requires system-wide representative values and/or robust estimates concerning: (i) selecting dimensions; (ii) measuring opportunity costs associated with each dimension; (iii) quantifying equity weights and percentages of beneficiaries and losers meeting equity considerations; and (iv) attaching monetary values to dimensions measured using a non-monetary metric. Conclusions Extending the cost-effectiveness analysis framework entails extending the measurement of the opportunity costs of funding decisions. This implies populating an ambitious puzzle that in some cases poses fundamental conceptual and empirical questions. Potential routes of further research that might facilitate such undertaking are proposed.

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Section: Extensions To the Single-sector Unidimensional Cea Frameworkmentioning

confidence: 99%

The Broader Opportunity Costs in the Broader Cost-Effectiveness Analysis Framework

Vallejo-Torres

2023

Appl Health Econ Health Policy

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“…Other countries allow a complementary approach by including broader non-health outcomes in certain settings (further details below), including, Canada (7), the Netherlands (8), and England (9). Non-health outcomes might include benefits affecting well-being, or benefits derived from healthcare delivery processes, beyond the care recipient or outside the healthcare sector (10).…”

Section: Introductionmentioning

confidence: 99%

“…In response to earlier criticism of the health-only scope of HTA, it has been suggested that a going-beyond-health approach could provide a richer evaluative space that is more reflective of social values (10). Indeed, the evidence presented below on how several countries already do so indicates the relevance of objectives that complement health maximization (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Expanding health technology assessment towards broader value: Ireland as a case study

Kinchin

Walshe

Normand

et al. 2023

Int J Technol Assess Health Care

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Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating “broader value” in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting “broader value” to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.

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“…While they presented compelling results, they did not find any evidence pertaining to mother–child bonding and there was a lack of in-depth discussion about communication and satisfaction with these records. Exploring these non-health outcomes can be crucial for providing a more holistic picture of the effectiveness of home-based records and result in insights of theoretical and practical relevance 14–17. This would capture the user experience to help improve the implementation of home-based records.…”

Section: Introductionmentioning

confidence: 99%

“…Exploring these non-health outcomes can be crucial for providing a more holistic picture of the effectiveness of home-based records and result in insights of theoretical and practical relevance. [14][15][16][17] This would capture the user experience to help improve the implementation of home-based records. Moreover, non-health outcomes may impact health outcomes, 14 although more studies need to be conducted to clarify this effect.…”

mentioning

confidence: 99%

Effects of the maternal and child health handbook and other home-based records on mothers’ non-health outcomes: a systematic review

et al. 2022

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ObjectiveThis review aimed to investigate the effects of the maternal and child health (MCH) handbook and other home-based records on mothers’ non-health outcomes.DesignSystematic review.Data sourcesPubMed, Web of Science, CINAHL, Academic Search Complete, PsycArticles, PsycINFO, SocINDEX, CENTRAL, NHS EED, HTA, DARE, Ichuushi and J-STAGE through 26 March 2022.Eligibility criteria for selecting studiesOriginal research articles examining home-based records and mothers’ non-health outcomes published in English or Japanese across various study designs.Data extraction and synthesisTwo independent reviewers extracted relevant data and assessed the risk of bias. We assessed the certainty of evidence for each study using the Grading of Recommendations Assessment, Development, and Evaluation approach. Due to the heterogeneity of the included studies, we conducted a narrative synthesis of their findings.ResultsOf the 4199 articles identified, we included 47 articles (20 in Japanese) in the review. Among the different types of home-based records, only the MCH handbook provided essential information about the mother–child relationship, and its use facilitated the mother–child bonding process. Mothers reported generally feeling satisfied with the use of home-based records; although their satisfaction with health services was influenced by healthcare providers’ level of commitment to using these records. While home-based records positively affected communication within the household, we observed mixed effects on communication between mothers/caregivers and healthcare providers. Barriers to effective communication included a lack of satisfactory explanations regarding the use of home-based records and personalised guidance from healthcare providers. These records were also inconsistently used across different health facilities and professionals.ConclusionsThe MCH handbook fostered the mother–child bond. Mothers were generally satisfied with the use of home-based records, but their engagement depended on how these records were communicated and used by healthcare providers. Additional measures are necessary to ensure the implementation and effective use of home-based records.PROSPERO registration numberCRD42020166545.

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Conceptualising ‘Benefits Beyond Health’ in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis

Cited by 6 publications

References 144 publications

The Broader Opportunity Costs in the Broader Cost-Effectiveness Analysis Framework

The Broader Opportunity Costs in the Broader Cost-Effectiveness Analysis Framework

Expanding health technology assessment towards broader value: Ireland as a case study

Effects of the maternal and child health handbook and other home-based records on mothers’ non-health outcomes: a systematic review

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