Cost-Value Analysis of Health Interventions: Introduction and Update on Methods and Preference Data

Nord, Erik

doi:10.1007/s40273-014-0212-4

Cited by 18 publications

(15 citation statements)

References 21 publications

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“…(iii) Research, into the reform of funding formula, has scarcely commenced. Nord has suggested how severity could be incorporated into decision making [69]. In the fourth sharing study reviewed earlier there is a funding formula which illustrates how a fixed budget may be allocated between services with a 20-fold difference in the cost/QALY while taking account of cost and severity.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, and contingent upon further confirmatory studies, the social preferences identified to date can only be accommodated with discretionary judgements. These should, minimally, be explicit and include a recognition of the independent importance of severity [30,69] and the need to fund 'cost ineffective' services when alternative treatments are not available.…”

Section: Discussionmentioning

confidence: 99%

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Health technology assessment (HTA) and economic evaluation: efficiency or fairness first

Richardson

Schlander

2018

Journal of Market Access & Health Policy

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The economic evaluation which supports Health Technology Assessment (HTA) should inform policy makers of the value to society conferred by a given allocation of resources. However, neither the theory nor practise of economic evaluation satisfactorily reflect social values. Both are primarily concerned with efficiency, commonly conceptualised as the maximisation of utility or quality adjusted life years (QALYs). The focus is upon the service and the benefits obtained from it. This has resulted in an evaluation methodology which discriminates against groups and treatments which the population would like to prioritise. This includes high cost treatments for patients with rare diseases. In contrast with prevailing methods, there is increasing evidence that the public would prefer a fairness-focused framework in which the service was removed from centre stage and replaced by the patient. However methods for achieving fairness are ad hoc and under-developed.The article initially reviews the theory of economic evaluation and argues that its focus upon individual utility and efficiency as defined by the theory omits potentially important social values. Some empirical evidence relating to population values is presented and four studies by the first author are reviewed. These indicate that when people adopt the social perspective of a citizen they have a preference for sharing the health budget in a way which does not exclude patients who require services that are not cost effective, such as orphan medicinal products (OMP’s) and treatments for patients with ultra-rare diseases (URD’s).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health technology assessment (HTA) and economic evaluation: efficiency or fairness first

Richardson

Schlander

2018

Journal of Market Access & Health Policy

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“…While a distributive justice framework prioritizes resource allocation to the sickest persons in a society, irrespective of the likelihood and magnitude of expected improvement, a DALY-aversion approach prioritizes the sickest persons only if they are likely to achieve the greatest health gains (Nord, 2015; Ubel et al, 2000). For example, in terms of CEA calculus, a health intervention that provides disability reduction of 0.4 to 0 is equivalent to one that provides reduction from 0.9 to 0.5; both interventions reduce disability by 0.4.…”

Section: Concerns Of Equity and Distributive Justice In Cea: Is The Qmentioning

confidence: 99%

“…The strength of a society’s concern for disease severity, or ‘vertical equity’, has been studied empirically by asking subjects how much more utility would have to be gained (or disability averted) for an intervention targeted at healthier individuals to be preferred over an intervention targeted at sicker individuals (Dolan, 1998; Nord, 2015; Nord & Johansen, 2014). Representing the point at which a society would permit less cost-effective interventions that address diseases of greater severity, this higher utility value demonstrates the conceptual divergence between CEA outcomes and the objective of distributive justice – a concept that must be considered when interpreting CEA models.…”

Section: Concerns Of Equity and Distributive Justice In Cea: Is The Qmentioning

confidence: 99%

“…Finally, cost value analysis adjusts results from cost-effectiveness analyses to reflect society-specific degrees of concern for prioritization of disability or disease severity (Nord, 2015). In a QALY-based analysis this is done by compressing mild to moderate utility states towards the upper end of the utility scale such that individual gains for the sick are preferred over gains for the comparatively healthy.…”

Section: Interpreting Cea Outcomes In Resource-limited Settings - Promentioning

confidence: 99%

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Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings

Rutstein

Price

Rosenberg³

et al. 2016

Global Public Health

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Cost-effectiveness analysis (CEA) is an increasingly appealing tool for evaluating and comparing health-related interventions in resource-limited settings. The goal is to inform decision-makers regarding the health benefits and associated costs of alternative interventions, helping guide allocation of limited resources by prioritizing interventions that offer the most health for the least money. Although only one component of a more complex decision-making process, CEAs influence the distribution of healthcare resources, directly influencing morbidity and mortality for the world’s most vulnerable populations. However, CEA-associated measures are frequently setting-specific valuations, and CEA outcomes may violate ethical principles of equity and distributive justice. We examine the assumptions and analytical tools used in CEAs that may conflict with societal values. We then evaluate contextual features unique to resource-limited settings, including the source of health-state utilities and disability weights; implications of CEA thresholds in light of economic uncertainty; and the role of external donors. Finally, we explore opportunities to help align interpretation of CEA outcomes with values and budgetary constraints in resource-limited settings. The ethical implications of CEAs in resource-limited settings are vast. It is imperative that CEA outcome summary measures and implementation thresholds adequately reflect societal values and ethical priorities in resource-limited settings.

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Beyond QALYs: Multi-criteria based estimation of maximum willingness to pay for health technologies

Nord

2017

Eur J Health Econ

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The QALY is a useful outcome measure in cost-effectiveness analysis. But in determining the overall value of and societal willingness to pay for health technologies, gains in quality of life and length of life are prima facie separate criteria that need not be put together in a single concept. A focus on costs per QALY can also be counterproductive. One reason is that the QALY does not capture well the value of interventions in patients with reduced potentials for health and thus different reference points. Another reason is a need to separate losses of length of life and losses of quality of life when it comes to judging the strength of moral claims on resources in patients of different ages. An alternative to the cost-per-QALY approach is outlined, consisting in the development of two bivariate value tables that may be used in combination to estimate maximum cost acceptance for given units of treatment-for instance a surgical procedure, or 1 year of medication-rather than for 'obtaining one QALY.' The approach is a follow-up of earlier work on 'cost value analysis.' It draws on work in the QALY field insofar as it uses health state values established in that field. But it does not use these values to weight life years and thus avoids devaluing gained life years in people with chronic illness or disability. Real tables of the kind proposed could be developed in deliberative processes among policy makers and serve as guidance for decision makers involved in health technology assessment and appraisal.

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Cost-Value Analysis of Health Interventions: Introduction and Update on Methods and Preference Data

Cited by 18 publications

References 21 publications

Health technology assessment (HTA) and economic evaluation: efficiency or fairness first

Health technology assessment (HTA) and economic evaluation: efficiency or fairness first

Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings

Beyond QALYs: Multi-criteria based estimation of maximum willingness to pay for health technologies

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