Leveraging the Similarities Between Cost-Effectiveness Analysis and Value-Based Healthcare

Walraven, Jelle; Jacobs, Maartje S; Groot, Carin A. Uyl–de

doi:10.1016/j.jval.2021.01.010

Cited by 17 publications

(19 citation statements)

References 32 publications

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“…Moreover, as mentioned previously, the costs of bDMARDs are expected to decrease over time, potentially diminishing their relevance in the choice between tapering or continuing treatment. This shift towards more value-centred outcomes aligns with the principles of value based healthcare (VBHC), where maximising patient and condition-specific outcomes in relation to costs is paramount 85…”

Section: Discussionmentioning

confidence: 88%

Cost–utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands

van Esveld,

Cox,

Kuijper

et al. 2023

Ann Rheum Dis

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ObjectivesCurrent guidelines recommend tapering biological disease-modifying antirheumatoid drugs (bDMARDs) in rheumatoid arthritis (RA) if the disease is under control. However, guidelines on tapering are lacking. Assessing cost-effectiveness of different tapering strategies might provide broader input for creating guidelines on how to taper bDMARDs in patients with RA. The aim of this study is to evaluate the long-term cost-effectiveness from a societal perspective of bDMARD tapering strategies in Dutch patients with RA, namely 50% dose reduction (tapering), discontinuation and a 50% dose reduction followed by discontinuation (de-escalation).MethodsUsing a societal perspective, a Markov model with a life-time horizon of 30 years was used to simulate 3-monthly transitions between Disease Activity 28 (DAS28)-defined health states of remission (<2.6), low disease activity (2.6<DAS28<3.2) and medium-high disease activity (DAS28>3.2). Transition probabilities were estimated through literature search and random effects pooling. Incremental costs, incremental quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits for each tapering strategy were compared with continuation. Deterministic, probabilistic sensitivity analyses and multiple scenario analyses were performed.ResultsAfter 30 years, the ICERs were €115 157/QALY lost, €74 226/QALY lost and €67 137/QALY lost for tapering, de-escalation and discontinuation, respectively; mainly driven by bDMARD cost savings and a 72.8% probability of a loss in quality of life. This corresponds to a 76.1%, 64.3% and 60.1% probability of tapering, de-escalation and discontinuation being cost-effective, provided a willingness-to-accept threshold of €50 000/QALY lost.ConclusionsBased on these analyses, the 50% tapering approach saved the highest cost per QALY lost.

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Section: Discussionmentioning

confidence: 88%

Cost–utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands

van Esveld,

Cox,

Kuijper

et al. 2023

Ann Rheum Dis

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“…The value-based healthcare system is a new framework adopted by many governments to improve healthcare services and user experience through the improvement of patient healthcare outcomes at the lowest possible cost, i.e., the value is determined as the ratio of outcomes to cost [114]. Preventive medicine and early intervention lowers the cost associated with the hospitalization of patients.…”

Section: Value-based Healthcare System and Personalized Healthcarementioning

confidence: 99%

Requirements for Energy-Harvesting-Driven Edge Devices Using Task-Offloading Approaches

et al. 2022

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Energy limitations remain a key concern in the development of Internet of Medical Things (IoMT) devices since most of them have limited energy sources, mainly from batteries. Therefore, providing a sustainable and autonomous power supply is essential as it allows continuous energy sensing, flexible positioning, less human intervention, and easy maintenance. In the last few years, extensive investigations have been conducted to develop energy-autonomous systems for the IoMT by implementing energy-harvesting (EH) technologies as a feasible and economically practical alternative to batteries. To this end, various EH-solutions have been developed for wearables to enhance power extraction efficiency, such as integrating resonant energy extraction circuits such as SSHI, S-SSHI, and P-SSHI connected to common energy-storage units to maintain a stable output for charge loads. These circuits enable an increase in the harvested power by 174% compared to the SEH circuit. Although IoMT devices are becoming increasingly powerful and more affordable, some tasks, such as machine-learning algorithms, still require intensive computational resources, leading to higher energy consumption. Offloading computing-intensive tasks from resource-limited user devices to resource-rich fog or cloud layers can effectively address these issues and manage energy consumption. Reinforcement learning, in particular, employs the Q-algorithm, which is an efficient technique for hardware implementation, as well as offloading tasks from wearables to edge devices. For example, the lowest reported power consumption using FPGA technology is 37 mW. Furthermore, the communication cost from wearables to fog devices should not offset the energy savings gained from task migration. This paper provides a comprehensive review of joint energy-harvesting technologies and computation-offloading strategies for the IoMT. Moreover, power supply strategies for wearables, energy-storage techniques, and hardware implementation of the task migration were provided.

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“…VBHC describes value as patient-centred health outcomes per unit costs. CEA and VBHC both agree that decision-making in healthcare should be based on a trade-off between health outcomes and healthcare costs using a outcomes/costs ratio 9. However, in CEA, health outcomes are based on generic HRQoL measures whereas in VBHC relevant outcomes have been defined as disease or care path-specific indicators.…”

Section: Introductionmentioning

confidence: 99%

Is the QCI framework suited for monitoring outcomes and costs in a teaching hospital using value-based healthcare principles? A retrospective cohort study

van Veghel,

van Dijk,

Klem

et al. 2024

BMJ Open

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ObjectivesThe objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between health outcomes and healthcare utilisation costs.DesignThis is a retrospective cohort study.SettingA teaching hospital in Rotterdam, The Netherlands.ParticipantsThe study was performed in two use cases. The bariatric population contained 856 patients of which 639 were diagnosed with morbid obesity body mass index (BMI) <45 and 217 were diagnosed with morbid obesity BMI ≥45. The breast cancer population contained 663 patients of which 455 received a lumpectomy and 208 a mastectomy.Primary and secondary outcome measuresThe quality cost indicator (QCI) was the primary measures and was defined asQCI = (resulting outcome * 100)/average total costs (per thousand Euros)where average total costs entail all healthcare utilisation costs with regard to the treatment of the primary diagnosis and follow-up care. Resulting outcome is the number of patients achieving textbook outcome (passing all health outcome indicators) divided by the total number of patients included in the care path.ResultsThe breast cancer and bariatric population had the highest resulting outcome values in 2020 Q4, 0.93 and 0.73, respectively. The average total costs of the bariatric population remained stable (avg, €8833.55, min €8494.32, max €9164.26). The breast cancer population showed higher variance in costs (avg, €12 735.31 min €12 188.83, max €13 695.58). QCI values of both populations showed similar variance (0.3 and 0.8). Failing health outcome indicators was significantly related to higher hospital-based costs of care in both populations (p <0.01).ConclusionsThe QCI framework is effective for monitoring changes in average total costs and relevant health outcomes on an institutional level. Health outcomes are associated with hospital-based costs of care.

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Leveraging the Similarities Between Cost-Effectiveness Analysis and Value-Based Healthcare

Cited by 17 publications

References 32 publications

Cost–utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands

Cost–utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands

Requirements for Energy-Harvesting-Driven Edge Devices Using Task-Offloading Approaches

Is the QCI framework suited for monitoring outcomes and costs in a teaching hospital using value-based healthcare principles? A retrospective cohort study

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