Departures from Cost-Effectiveness Recommendations: The Impact of Health System Constraints on Priority Setting

Hauck, Katharina; Thomas, Ranjeeta; Smith, Peter

doi:10.1080/23288604.2015.1124170

Cited by 32 publications

(34 citation statements)

References 23 publications

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“…Despite the declared commitment to health equity, most health systems around the world (from macro to micro) are still routinely making decisions on choosing new health interventions based on economic evaluations and maximizing health outcomes, often measured in qualityadjusted life-years (QALYs) [12,13]. Hence, decisionmakers intrinsically balance quality of care and financial outcome parameters [14], but rarely make decisions based on the trade-offs between the economic and equity distributions of the health outcomes [4].…”

Section: Health Equity: Definition and Importancementioning

confidence: 99%

Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol

et al. 2020

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Background: Equity in health has become an important policy agenda around the world, prompting health economists to advance methods to enable the inclusion of equity in economic evaluations. Among the methods that have been proposed to explicitly include equity are the weighting analysis, equity impact analysis, and equity trade-off analysis. This is a new development and a comprehensive overview of trends and concepts of health equity in economic evaluations is lacking. Thus, our objective is to map the current state of the literature with respect to how health equity is considered in economic evaluations of health interventions reported in the academic and gray literature. Methods: We will conduct a scoping review to identify and map evidence on how health equity is considered in economic evaluations of health interventions. We will search relevant electronic, gray literature and key journals. We developed a search strategy using text words and Medical Subject Headings terms related to health equity and economic evaluations of health interventions. Articles retrieved will be uploaded to reference manager software for screening and data extraction. Two reviewers will independently screen the articles based on their titles and abstracts for inclusion, and then will independently screen a full text to ascertain final inclusion. A simple numerical count will be used to quantify the data and a content analysis will be conducted to present the narrative; that is, a thematic summary of the data collected. Discussion: The results of this scoping review will provide a comprehensive overview of the current evidence on how health equity is considered in economic evaluations of health interventions and its research gaps. It will also provide key information to decision-makers and policy-makers to understand ways to include health equity into the prioritization of health interventions when aiming for a more equitable distribution of health resources.

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Section: Health Equity: Definition and Importancementioning

confidence: 99%

Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol

et al. 2020

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“…The most important of these are the related issues of budget impact and optimal resource allocation. Careful budget impact analysis is a critical adjunct to effectiveness and cost-effectiveness evidence, since cost-effective interventions may be unaffordable or infeasible if they require large increases in human resources and capital in order to be delivered (so-called ‘transition costs’) 23. An additional analytical step—resource allocation across diseases—requires additional modelling in light of budgetary constraints 24…”

Section: Priority Cvd Interventions To Include In Uhcmentioning

confidence: 99%

Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries

Watkins

Nugent

2017

Heart Asia

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Over the past decade, universal health coverage (UHC) has emerged as a major policy goal for many low-and middle-income country governments. Yet, despite the high burden of cardiovascular diseases (CVD), relatively little is known about how to address CVD through UHC. This review covers three major topics. First, we define UHC and provide some context for its importance, and then we illustrate its relevance to CVD prevention and treatment. Second, we discuss how countries might select high-priority CVD interventions for a UHC health benefits package drawing on economic evaluation methods. Third, we explore some implementation challenges and identify research gaps that, if addressed, could improve the inclusion of CVD into UHC.

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“…in human resources and capital infrastructures) have long-term implications that are to a degree fixed and often cannot easily be changed in future. [ 6 ] In such situations, it is not evident that the unit costs used in economic evaluation studies, which typically are the long-run average costs or prices at which resources are purchased, suitably reflect the true value of resources in terms of their contributions to improving health. This is especially the case where resources are not traded on open, competitive markets that can respond effectively to price signals (such as with the employment of skilled health care workers, such as nurses) or where they are fixed assets, the prices of which are determined long in advance and where subsequent realisation of uncertainties changes their values.…”

Section: Introductionmentioning

confidence: 99%

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

Revill

Walker

Cambiano³

et al. 2018

PLoS ONE

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BackgroundThe WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients.Key issues for economic evaluationThe cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter’s value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health.ImplicationsThe findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.

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Departures from Cost-Effectiveness Recommendations: The Impact of Health System Constraints on Priority Setting

Cited by 32 publications

References 23 publications

Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol

Mapping the evidence on health equity considerations in economic evaluations of health interventions: a scoping review protocol

Setting priorities to address cardiovascular diseases through universal health coverage in low- and middle-income countries

Reflecting the real value of health care resources in modelling and cost-effectiveness studies—The example of viral load informed differentiated care

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