How Does Cost-Effectiveness Analysis Inform Health Care Decisions?

Kim, David D.; Basu, Anirban

doi:10.1001/amajethics.2021.639

Cited by 33 publications

(9 citation statements)

References 29 publications

(34 reference statements)

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“…It will also be important for studies to thoroughly describe MIH interventions using accepted implementation frameworks such as Reach Effectiveness Adoption Implementation Maintenance ( Glasgow et al, 1999 ) and Consolidated Framework for Implementation Research ( Damschroder et al, 2009 ); these frameworks help identify metrics that can be used to improve success and outcomes of a respective health care program ( Holtrop et al, 2018 ; King et al, 2020 ). Moreover, high-quality evidence from well-powered, RCTs is needed to quantify the effectiveness of MIH ( Kim & Basu, 2021 ). Few of the studies we reviewed employed RCT designs.…”

Section: Discussionmentioning

confidence: 99%

Mobile Integrated Health Interventions for Older Adults: A Systematic Review

Louras

Turchioe

Topaz

et al. 2023

Innovation in Aging

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Background and Objectives Mobile Integrated Health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least two independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (five studies) and immediate emergency department (ED) transports (three studies). The three studies examining subsequent ED visits and four studies examining readmission rates reported mixed results. Studies reported low adverse event rates (five studies), high patient and provider satisfaction (five studies), and costs equivalent to or less than usual paramedic care (three studies). Discussion and Implications There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Mobile Integrated Health Interventions for Older Adults: A Systematic Review

Louras

Turchioe

Topaz

et al. 2023

Innovation in Aging

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“…An International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Special Task Force defined elements of value that can be added to CEA calculations [ 21 ]. The QALY is one of twelve elements of value identified by the ISPOR task group, and was never intended to be used as a single decision-making threshold [ 44 ]. We agree that maximizing QALYs while ignoring the populations in which they are produced ignores multiple elements of value important to society.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Pinto

Heinemann

Chang

et al. 2023

J NeuroEngineering Rehabil

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Background Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. Methods A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. Results Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. Conclusions The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.

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“…Morrow and Simpson (2022) describe cost-effectiveness analysis (CEA) as a method for economic evaluation and provide an example to illustrate the utility of CEA using a hypothetical new intervention for stroke rehabilitation. CEA is growing more common in many areas of health care, and the demand for CEA to help inform decisions about care provision in the United States continues to increase (Kim & Basu, 2021). The underutilization of CEA in occupational therapy research represents an opportunity to use this approach to study the value of occupational therapy and promote high-value services to key stakeholders.…”

Section: Cost-effectiveness Of Occupational Therapymentioning

confidence: 99%

Health Services Research and Occupational Therapy: Ensuring Quality and Cost-Effectiveness

Hand

Mroz

2022

The American Journal of Occupational Therapy

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Health services research focuses on access, quality, and cost-effectiveness of care. As a result of increasing emphasis on value-based reimbursement models, conducting health services research to demonstrate the value of occupational therapy is timely. This special issue serves to highlight health services research relevant to occupational therapy practice. Articles included in this special issue describe (1) clients’ access to and use of occupational therapy, (2) the effects of occupational therapy on important quality-of-care indicators and client outcomes, and (3) the value of occupational therapy services through the lens of cost-effectiveness. This special issue illustrates the state of health services research in the field of occupational therapy and reveals key insights to advance occupational therapy practice using health services research.

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How Does Cost-Effectiveness Analysis Inform Health Care Decisions?

Cited by 33 publications

References 29 publications

Mobile Integrated Health Interventions for Older Adults: A Systematic Review

Mobile Integrated Health Interventions for Older Adults: A Systematic Review

Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Health Services Research and Occupational Therapy: Ensuring Quality and Cost-Effectiveness

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