Session 4.4 – Economic Evaluation and Priority Setting
Thursday October 30 11:30-12:30
The Economic Evaluation of Stroke Service Configuration Using a Decision Analysis Framework: Hurdles to Jump.
(Abstract 0062)Fiona Shrive1, Joanne Gray2, Cameron Donaldson2
1University of Calgary, Canada, 2University of Newcastle Upon Tyne, United Kingdom
Background: We address the methodological and practical issues of applying decision analysis tools to complex health system changes. Using an illustrative example of stroke service configuration, we document the difficulties of applying a decision analysis framework to the economic evaluation of service configuration.
Methods: A model was developed by an interdisciplinary team including experienced stroke clinicians and senior health economists to evaluate different service configurations for stroke care in Northeast England. Four methodological concerns were identified.
Results: First, there is limited availability of applicable data. RCT data comparing service configurations is scarce. Efficacy of various service configurations in comparison to the current configuration is simply not available. Second, identification of the appropriate comparators is nebulous. The feasible service configurations are deeply embedded within the context of the current health care system. Identification of manageable, realistic changes is difficult. This, in turn, limits the generalisability and comparability of any economic decision model. Third, quantifying the knock-on effects of any service configuration change is difficult. The real impact on health care delivery, within and across the particular service, is difficult to quantify. Lastly, the aspects that are valued within service configuration changes are more broad than health. A variety of political, contextual and societal forces are involved in service configuration changes. Decision analysis is unable to include these values.
Conclusions: The use of a decision analysis framework to assess service configurations has many methodological challenges. The broad application of decision analysis must be carefully weighed against the methods strengths and weaknesses.
Economic Evaluation of Health Interventions: Tanzania Perspectives
(Abstract 0119)Bjarne Robberstad1, Yusuf Hemed2
1University of Bergen, Norway, 2MEASURE Evaluation, Tanzania, United Republic of
Background: The life expectancy of Tanzania has declined since 1990, and the health care services are facing immense challenges. The two single most important sources of burden of disease in the country are HIV/AIDS and malaria. Cardiovascular and other non-communicable diseases are also becoming increasingly important causes of disease burden.
Objectives & Methods: This paper reviews the available economic evaluation literature for all types of health interventions in Tanzania. Economic evaluation is useful for setting health care priorities when decision makers are concerned about producing as much health benefits as possible within the limits of scarce health care resources.
Results: A total of 23 studies were found reporting costs and benefits for health interventions. The studies included in the review can roughly be sorted into the disease groups malaria, HIV/AIDS, maternal and perinatal health, intestinal parasites and worms, tuberculosis (TB), childhood diseases and cardiovascular disorders. The economic evaluation evidence for Tanzania is generally very scarce. Evidence is relatively good for malaria interventions and interventions against intestinal worms and parasites. Within these disease groups economic evaluation can be particularly useful to inform implementation policy. For all other disease groups, evidence is either vastly insufficient or totally missing. Lack of evidence is particularly striking for treatment and care of patients with HIV/AIDS, and for non-communicable diseases.
Policy Implications: Economic evaluation can in most cases not be used efficiently and consistently to set health care priorities in Tanzania. More research is needed to improve this situation.
Allocating Systemic Cancer Therapy when Resources are Limited
(Abstract 0158)Hugh Walker
Queen’s University, Canada
Background: Canada’s cancer patients have benefited from new and more effective drugs. These are more expensive than their predecessors, and cancer funding in Canada is now too limited for every patient to receive the newest drugs.
Objective: Manage the scarcity of cancer resources while providing the best achievable care to a cancer patient cohort. Provide efficient and equitable care.
- Efficient: Limited resources allocated among patients to achieve greatest total benefit (Life Years or QALYs.)
- Equitable: No patient may be denied all treatments because some patients receive new, expensive regimens. All patients who might benefit from a regimen have some chance of receiving it.
Methods: Model makes optimal drug allocations for major cancers based on the objective of achieving maximum survival for the cohort in question while constrained by limitations in funding, oncologists, nurses, pharmacists, and clinic space. The model uses Linear Programming to find an optimal solution. Data is from the Program for Evidence-based Care website of Cancer Care Ontario.
Results: The model shows patients, by site and stage, receiving each regimen with the resources available. Exploring different resource availability scenarios shows what is needed to achieve particular levels of cohort survival, and to introduce a new systemic therapy.
Policy Implications: The model provides cancer managers with a transparent, evidence-based method for allocating funding for systemic therapy. Planners can test drug policies and resource strategies to see which provide the best results for the money.