Welfarism Versus Extra-Welfarism: Can the Choice of Economic Evaluation Approach Impact on the Adoption Decisions Recommended by Economic Evaluation Studies?

Abstract

A long-running debate surrounds the equivalence of the welfarist and extra-welfarist approaches to economic evaluation. There is a growing belief that the extra-welfarist approach may not necessarily provide all the information that decisionmakers require in certain contexts, e.g. evaluation of complex interventions. As the number of these interventions being evaluated increases, it is crucial that the most appropriate economic evaluation approach is used to enable decisionmakers to be confident in their adoption decisions. We conducted a literature review to evaluate the potential for the choice of economic evaluation approach to impact on the adoption decisions recommended by economic evaluation studies. We found that for every five studies applying both approaches, one shows limited or no concordance in economic evaluation results: the different approaches suggest conflicting adoption decisions, and there is no pattern to which approach provides the most convincing adoption evidence. Only one study in ten indicates which results will best inform adoption decisions. We conclude that the choice of approach can significantly impact on the adoption decisions recommended by economic evaluation studies, with conflicting results creating confusion over whether or not interventions provide good value for money. Health economists rarely provide sufficient guidance to decisionmakers to alleviate this confusion.

Patients’ Preferences for Genomic Diagnostic Testing in Chronic Lymphocytic Leukaemia: A Discrete Choice Experiment

“…However, given the importance that CLL patients attached to process-related outcomes, the most appropriate form of economic evaluation could instead be a cost-benefit analysis (CBA), in which health outcomes are expressed in monetary terms, informed by the WTP estimates generated by this DCE. However, CBAs are rarely undertaken at present as they are not valued by HTA agencies such as the National Institute for Health and Care Excellence in the UK [49]. Future work which demonstrates that CBAs are a valid approach in this context would make a notable contribution to this area.…”

Incorporating Quantitative Patient Preference Data into Healthcare Decision Making Processes: Is HTA Falling Behind?

“…One issue with the QALY is that it is not easy to incorporate broader outcomes or the ''patient experience'' into health state utilities, which is why projects such as ''Extending the QALY'' are currently being conducted [36]. Regardless, patients have been shown to adapt to their conditions [37,38], and a movement away from using general population preferences would represent an ideological change relating to the perspective of CUAs (i.e., movement away from extra-welfarism [39][40][41]). Therefore, using patient preferences within a CUA could be controversial irrespective of the benefit measure.…”

A Review of Health Economic Studies Comparing Traditional and Massively Parallel Sequencing Diagnostic Pathways for Suspected Genetic Disorders

“…The quality of included full economic evaluations was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist [24] (See Appendix 2 Supplementary Table S1) . As per a recent study [25], we assigned scores to each of the 24 items (1 = item fully addressed; 0.5 = item partially addressed; 0 = item not addressed; no score = item not applicable). All items were weighted equally.…”