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- Colson, Abigail R., et al.
(författare)
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Antimicrobial Resistance : Is Health Technology Assessment Part of the Solution or Part of the Problem?
- 2021
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 24:12, s. 1828-1834
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Tidskriftsartikel (refereegranskat)abstract
- Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.
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- Henriksson, Martin, et al.
(författare)
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Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery
- 2010
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Ingår i: BRITISH MEDICAL JOURNAL. - : BMJ. - 0959-535X. ; 340
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Tidskriftsartikel (refereegranskat)abstract
- Objective To determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Design Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Data sources Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers. Results The observed risk of cardiovascular events while on the waiting list for coronary artery bypass grafting was 3 per 10 000 patients per day within the first 90 days (184 events in 9935 patients). Using a cost effectiveness threshold of 20 pound 000-30 pound 000 ((sic)22 000-(sic)33 000; $32 000-$48 000) per additional QALY, a prioritisation strategy using a risk score with estimated glomerular filtration rate was the most cost effective strategy (cost per additional QALY was andlt;410 pound compared with the Ontario urgency score). The impact on population health of implementing this strategy was 800 QALYs per 100 000 patients at an additional cost of 245 pound 000 to the National Health Service. The prioritisation strategy using a risk score with C reactive protein was associated with lower QALYs and higher costs compared with a risk score using estimated glomerular filtration rate. Conclusion Evaluating the cost effectiveness of prognostic biomarkers is important even when effects at an individual level are small. Formal prioritisation of patients awaiting coronary artery bypass grafting using a routinely assessed biomarker (estimated glomerular filtration rate) along with simple, routinely collected clinical information was cost effective. Prioritisation strategies based on the prognostic information conferred by C reactive protein, which is not currently measured in this context, or a combination of C reactive protein and estimated glomerular filtration rate, is unlikely to be cost effective. The widespread practice of using only implicit or informal means of clinically ordering the waiting list may be harmful and should be replaced with formal prioritisation approaches.
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| 7. |
- Henriksson, Martin, et al.
(författare)
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The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial
- 2008
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Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 94, s. 717-723
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Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy. Objective: The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective. Design: Decision-analytic model based on randomised clinical trial data. Main outcome measures: Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio. Methods: Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients’ lifetimes within the decision-analytic model. Results: The mean incremental cost per QALY gained for an early interventional strategy was approximately £55 000, £22 000 and £12 000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of £20 000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect. Conclusion: An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk.
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| 8. |
- Johannesen, Kasper M, et al.
(författare)
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How to design the cost‐effectiveness appraisal process of new healthcare technologies to maximise population health : A conceptual framework
- 2018
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Ingår i: Health Economics. - : John Wiley & Sons. - 1057-9230 .- 1099-1050. ; 27:2, s. e41-e54
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents a conceptual framework to analyse the design of the cost‐effectiveness appraisal process of new healthcare technologies. The frameworkcharacterises the appraisal processes as a diagnostic test aimed at identifyingcost‐effective (true positive) and non‐cost‐effective (true negative) technologies.Using the framework, factors that influence the value of operating an appraisalprocess, in terms of net gain to popula tion health, are identified. The frame-work is used to gain insight into current policy questions including (a) howrigorous the process should be, (b) who should have the burden of proof, and(c) how optimal design changes when allowing for appeals, price reductions,resubmissions, and re‐evaluations.The paper demonstrates that there is no one optimal appraisal process and theprocess should be adapted over time and to the specific technology underassessment. Optimal design depends on country‐specific features of (future)technologies, for example, effect, price, and size of the patient population,which might explain the difference in appraisal processes across countries. Itis shown that burden of pro of should be placed on the producers and that theimpact of price reductions and patient access schemes on the producer's pricesetting should be considered when designing the appraisal process.
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| 9. |
- Sampaio, Filipa, 1985-
(författare)
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Prevention and Treatment of Externalizing Behaviour Problems in Children through Parenting Interventions : An Application of Health Economic Methods
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The early onset of externalizing behaviour problems (EBP) is associated with negative outcomes later in life, such as poor mental health, substance use, crime, and unemployment. Some children also develop conduct disorder (CD), entailing a high disease and economic burden for both individuals and society.Most studies on the effectiveness and cost-effectiveness of parenting interventions targeting EBP among children have evaluated selective or indicated preventive interventions, or treatment strategies. Evidence on the effectiveness of universally delivered parenting programmes is controversial, partly due to methodological difficulties.The overall aim of this thesis was to 1) address the methodological challenges of evaluating universal parenting programmes, and to 2) employ different health economic methods to evaluate parenting interventions for EBP and CD in children.Study I indicated that offering low intensity levels of Triple P universally, with limited intervention attendance, does not result in improved outcomes, and may not be a worthwhile use of public resources. Study II showed that using the distribution of an outcome variable makes it possible to estimate the impact of public health interventions at the population level. Study III supports offering bibliotherapy to initially target CP in children, whereas Comet could be offered to achieve greater effects based on decision-makers’ willingness to make larger investments. Cope could be offered when targeting symptom improvement, rather than clinical caseness. The economic decision model in Study IV demonstrated that Triple P for the treatment of CD appears to represent good value for money, when delivered in a Group format, but less likely, when delivered in an Individual format.To reduce the burden of mental health problems in childhood, cost-effective and evidence-based interventions should be provided on a continuum from prevention through early intervention to treatment. We believe our results can assist decision-makers in resource allocation to this field.
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