Priority setting in health: origins, description and application of the Australian Assessing Cost–Effectiveness initiative

Carter, Rob; Vos, Theo; Moodie, Marj; Haby, Michelle M.; Magnus, Anne; Mihalopoulos, Cathrine

doi:10.1586/14737167.8.6.593

Cited by 132 publications

(160 citation statements)

References 27 publications

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“…Technical cost-effectiveness analysis should be combined with other approaches that facilitate 'due process' [8]. Issues relating to the feasibility, sustainability and acceptability associated with the implementation of these interventions were considered alongside the results of the technical analysis in the Assessing Cost-effectiveness: Prevention Project [8].…”

Section: Discussionmentioning

confidence: 99%

“…Issues relating to the feasibility, sustainability and acceptability associated with the implementation of these interventions were considered alongside the results of the technical analysis in the Assessing Cost-effectiveness: Prevention Project [8]. The pertinent issues include workforce capacity and feasibility of GP participation.…”

Section: Discussionmentioning

confidence: 99%

“…This enables comparison of different interventions in order to identify the most cost-effective prevention strategy available. This study forms part of a larger project, the Assessing Costeffectiveness-Prevention Project, which aims to evaluate the cost-effectiveness of 100 preventive interventions for noncommunicable disease [8].…”

Section: Introductionmentioning

confidence: 99%

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Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care

et al. 2010

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Aims/hypothesis This study aims to evaluate the costeffectiveness of a screening programme for pre-diabetes, which was followed up by treatment with pharmaceutical interventions (acarbose, metformin, orlistat) or lifestyle interventions (diet, exercise, diet and exercise) in order to prevent or slow the onset of diabetes in those at high risk. Methods To approximate the experience of individuals with pre-diabetes in the Australian population, we used a microsimulation approach, following patient progression through diabetes, cardiovascular disease and renal failure. The model compares costs and disability-adjusted life years lived in people identified through an opportunistic screening programme for each intervention compared with a 'do nothing' scenario, which is representative of current practice. It is assumed that the effect of a lifestyle change will decay by 10% per year, while the effect of a pharmaceutical intervention remains constant throughout use. Results The most cost-effective intervention options are diet and exercise combined, with a cost-effectiveness ratio of AUD 22,500 per disability-adjusted life year (DALY) averted, and metformin with a cost-effectiveness ratio of AUD 21,500 per DALY averted. The incremental addition of one intervention to the other is not cost-effective. Conclusions/interpretation Screening for pre-diabetes followed by diet and exercise, or metformin treatment is costeffective and should be considered for incorporation into current practice. The number of dietitians and exercise physiologists needed to deliver such lifestyle change interventions will need to be increased to appropriately support the intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care

et al. 2010

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“…Disease Based Model, Health Benefits Group/Health Resource Group, have been described [23][24][25][26][27][28] .…”

Section: Similar Approaches Such As Ace (Assessing Cost Effectivenesmentioning

confidence: 99%

Breaking up is hard to do: why disinvestment in medical technology is harder than investment

Haas¹,

Hall²,

Viney³

et al. 2012

Aust. Health Review

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Health care technology is a two-edged sword-it offers new and better treatment to a wider range of people and at the same time is a major driver of increasing costs in health systems. Many countries have developed sophisticated systems of Health Technology Assessment (HTA) to inform decisions about new investments in new health care interventions. In this paper we question whether HTA is also the appropriate framework for guiding or informing disinvestment decisions.In exploring the issues related to disinvestment, we first discuss the various HTA frameworks which have been suggested as a means of encouraging or facilitating disinvestment. We then describe available means of identifying candidates for disinvestment (Comparative Effectiveness Research, clinical practice variations, clinical 2 practice guidelines) and for implementing the disinvestment process (PBMA and related techniques).In considering the possible reasons for the lack of progress in active disinvestment we suggest that HTA is not the right framework as disinvestment involves a different decision making context. The key to disinvestment is not just what to stop doing but how to make it happen-that is decision makers need to be aware of funding disincentives. 3 Key Question SummaryWhat is known about this topic?Disinvestment is an increasingly popular topic amongst academics and policy makers.Most discussions focus on the need to increase disinvestment as a corollary of investment, the lack of overt disinvestment decisions and the use of a framework based on health technology assessment (HTA) to implement disinvestment. What does this paper add?This paper focuses on the difficulties associated with deciding which technologies to disinvest in and the problems in using an HTA framework to make such decisions when disinvestment involves a different decision making context from that of investment.What are the implications for practitioners?The key to disinvestment is not just what to stop doing but how to implement such decisions. Making it happen means being aware of funding disincentives.

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“…The rationale and methodology have been explained elsewhere. 12 Previous studies that were part of ACE prevention reported on physical activity and alcohol interventions. 13,14 We recently reported that 'traffic-light' nutrition labelling and 'junk-food' tax offer excellent value for money as obesity prevention measures.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity

et al. 2011

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Objective: To analyze whether two dietary weight loss interventionsFthe dietary approaches to stop hypertension (DASH) program and a low-fat diet programF would be cost-effective in Australia, and to assess their potential to reduce the disease burden related to excess body weight. Design: We constructed a multi-state life-table-based Markov model in which the distribution of body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. The target population was the overweight and obese adult population in Australia in 2003. We used a lifetime horizon for health effects and costs, and a health sector perspective for costs. We populated the model with data identified from Medline and Cochrane searches, Australian Bureau of Statistics published catalogues, Australian Institute of Health and Welfare, and Department of Health and Ageing. Outcome measures: Disability adjusted life years (DALYs) averted, incremental cost-effectiveness ratios (ICERs) and proportions of disease burden avoided. ICERs under AUS$50 000 per DALY are considered cost-effective. Results: The DASH and low-fat diet programs have ICERs of AUS$12 000 per DALY (95% uncertainty range: Cost-savingF68 000) and AUS$13 000 per DALY (Cost-savingF130 000), respectively. Neither intervention reduced the body weight-related disease burden at population level by more than 0.1%. The sensitivity analysis showed that when participants' costs for time and travel are included, the ICERs increase to AUS$75 000 per DALY for DASH and AUS$49 000 per DALY for the low-fat diet. Modest weight loss during the interventions, post-intervention weight regain and low participation limit the health benefits. Conclusion: Diet and exercise interventions to reduce obesity are potentially cost-effective but have a negligible impact on the total body weight-related disease burden.

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Priority setting in health: origins, description and application of the Australian Assessing Cost–Effectiveness initiative

Cited by 132 publications

References 27 publications

Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care

Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care

Breaking up is hard to do: why disinvestment in medical technology is harder than investment

Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity

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