This document provides an overview of health economics concepts for public health. It discusses basics of health economics including cost effectiveness, return on investment, and prevention. It also covers obtaining better value in health care and social care systems. Key concepts discussed include diminishing marginal returns, average vs incremental costs, opportunity cost, priority setting, and population impact. The document cautions against spending too much on innovations without strong evidence of value. It emphasizes evaluating the incremental costs and benefits of interventions compared to existing options.
Behavioural economics in Financial Services: Perspectives and Prospects Eversheds Sutherland
Behavioural Economics: The power of predictable irrationality – 6th May 2014
Behavioural economics looks set to become an intrinsic part of the Financial Conduct Authority’s approach to regulation. This seminar outlines presentations from Nottingham University Business School and Eversheds LLP to explore:
• What behavioural economics can tell us about consumer decision making in financial markets;
• The scope that the FCA envisage behavioural economics will have in improving the regulation of financial conduct; and
• The implications for your business.
This document summarizes an economic assessment of a cognitive behavioral therapy (CBT) service provided to employees of Cardiff Council in Wales who were experiencing stress, anxiety, or depression. Over three years, 141 employees were referred to the service. Of those, 77 were deemed likely to benefit from CBT and 51 completed CBT treatment. The economic assessment found that the costs of setting up and running the CBT service were offset by reductions in sick leave days and associated costs. Providing CBT in the workplace improved employee health and productivity while reducing costs for the employer.
This document discusses economic evaluation in healthcare decision making. It defines economic evaluation as using scientific methods to compare costs and benefits of alternative interventions. The main types of economic evaluation are described as cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-minimization analysis. The document outlines the generic steps in economic evaluation including defining the question, identifying and valuing costs and benefits, analyzing costs and benefits, and determining decision rules based on incremental cost-effectiveness ratios. Limitations of economic evaluation for resource allocation are discussed, noting that many factors beyond cost-effectiveness play a role in funding decisions.
This document discusses issues related to prevention and return on investment (ROI) in healthcare. It addresses why prevention has not been more widely implemented in the NHS despite the economic case. Barriers include lack of incentives, complex evidence, and culture change. Cost-effectiveness does not equal cost savings. Prevention may release cash in long term rather than short term. ROI tools can oversimplify and make unrealistic assumptions. Obesity prevention is used as an example, highlighting challenges around individual versus population interventions and timeframes for cost savings.
This document provides an overview of health economics and its role in public health. It begins by defining health economics as using an economic framework to help maximize population health given constrained resources. It then discusses the various analyses health economists perform, including economic evaluations like cost-effectiveness analysis. It provides examples of how economics can inform decisions around public health programs and resource allocation in India. Key points made include that health resources are limited so choices must be made, and that economic evaluations can help identify which health interventions provide the best value. The conclusion emphasizes that health economics should be integrated into health policy and management to help make resource decisions more explicit and fair.
Housing associations already deliver a range of services to promote health, wellbeing and independence for many different populations including older people and those with enduring mental health problems. Recent reforms to the health system, including measures to increase co-operation and joint commissioning of services with the social care sector, will both create opportunities for housing associations and have implications for the ways in which housing associations enter into the healthcare market.
Quality, Innovation, Productivity and Prevention in Primary CareNHSScotlandEvent
What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.
Behavioural economics in Financial Services: Perspectives and Prospects Eversheds Sutherland
Behavioural Economics: The power of predictable irrationality – 6th May 2014
Behavioural economics looks set to become an intrinsic part of the Financial Conduct Authority’s approach to regulation. This seminar outlines presentations from Nottingham University Business School and Eversheds LLP to explore:
• What behavioural economics can tell us about consumer decision making in financial markets;
• The scope that the FCA envisage behavioural economics will have in improving the regulation of financial conduct; and
• The implications for your business.
This document summarizes an economic assessment of a cognitive behavioral therapy (CBT) service provided to employees of Cardiff Council in Wales who were experiencing stress, anxiety, or depression. Over three years, 141 employees were referred to the service. Of those, 77 were deemed likely to benefit from CBT and 51 completed CBT treatment. The economic assessment found that the costs of setting up and running the CBT service were offset by reductions in sick leave days and associated costs. Providing CBT in the workplace improved employee health and productivity while reducing costs for the employer.
This document discusses economic evaluation in healthcare decision making. It defines economic evaluation as using scientific methods to compare costs and benefits of alternative interventions. The main types of economic evaluation are described as cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-minimization analysis. The document outlines the generic steps in economic evaluation including defining the question, identifying and valuing costs and benefits, analyzing costs and benefits, and determining decision rules based on incremental cost-effectiveness ratios. Limitations of economic evaluation for resource allocation are discussed, noting that many factors beyond cost-effectiveness play a role in funding decisions.
This document discusses issues related to prevention and return on investment (ROI) in healthcare. It addresses why prevention has not been more widely implemented in the NHS despite the economic case. Barriers include lack of incentives, complex evidence, and culture change. Cost-effectiveness does not equal cost savings. Prevention may release cash in long term rather than short term. ROI tools can oversimplify and make unrealistic assumptions. Obesity prevention is used as an example, highlighting challenges around individual versus population interventions and timeframes for cost savings.
This document provides an overview of health economics and its role in public health. It begins by defining health economics as using an economic framework to help maximize population health given constrained resources. It then discusses the various analyses health economists perform, including economic evaluations like cost-effectiveness analysis. It provides examples of how economics can inform decisions around public health programs and resource allocation in India. Key points made include that health resources are limited so choices must be made, and that economic evaluations can help identify which health interventions provide the best value. The conclusion emphasizes that health economics should be integrated into health policy and management to help make resource decisions more explicit and fair.
Housing associations already deliver a range of services to promote health, wellbeing and independence for many different populations including older people and those with enduring mental health problems. Recent reforms to the health system, including measures to increase co-operation and joint commissioning of services with the social care sector, will both create opportunities for housing associations and have implications for the ways in which housing associations enter into the healthcare market.
Quality, Innovation, Productivity and Prevention in Primary CareNHSScotlandEvent
What do the Quality Ambitions mean for Primary Care? This session describes the ongoing innovative local improvements and national work with NHS
Boards and Primary Care contractors to improve quality, efficiency and outcomes as well as the future plans for Primary Care.
A presentation to a National Institute of Health Research consultation event on identifying priorities for public health research for the next five years
This document provides information about Dr. Paul Cornes and his conflicts of interest. It discloses that Dr. Cornes receives salary from the UK National Health Service and has received honoraria from several pharmaceutical companies. The document then discusses challenges in setting reimbursement thresholds for new cancer treatments, including that many new drugs approved in 2012 cost over $100,000 annually but provided only small survival benefits. It also considers options for containing future health spending and the need to balance health spending with economic growth.
This document provides an introduction to economic and cost-effectiveness analyses in healthcare. It outlines four main types of analyses: cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. For each type of analysis, it describes how costs and health outcomes are considered. It also discusses important aspects like perspective, time frame, discounting, estimating costs, and identifying health outcomes. The goal is to help learners understand why economic analyses are relevant for health policy and research decisions.
1) Sovaldi (a Hepatitis C drug) was found to be cost-effective by NICE in the UK, but at £1 billion per year it is not affordable for the NHS if all eligible patients are treated. Other European countries have sought large discounts and imposed treatment caps to limit spending.
2) There are different ways to think about drug affordability - whether a cost is absolutely unaffordable, if payers need time to adjust spending, or if payers want to cap returns to "reasonable" levels through discounts.
3) Annualizing payments by charging for the drug's benefits over several years through amortization or annual fees is one way to address high upfront costs of
This document discusses cost-effectiveness analysis for evaluating health interventions. It defines efficacy versus effectiveness, and cost-effectiveness as assessing whether health improvements are worth the additional costs. The document outlines methods for cost-effectiveness analysis including identifying alternatives, measuring outcomes and costs, and using decision rules. Key points covered include measuring outcomes directly, considering both short and long term costs and benefits, and discounting future values.
Comparative Effectiveness: UCSF East Africa Global Health -Kisumu 2014GlobalResearchUCSF
The document describes an upcoming cost-effectiveness analysis workshop to be held in Kisumu, Kenya on January 20, 2014. The purpose of the workshop is to provide participants with a basic understanding of cost-effectiveness analysis concepts and methods and allow them to apply these concepts to an issue of their choosing. The workshop will cover core CEA approaches such as calculating incremental cost per standardized unit of health gain compared to alternative interventions and key metrics like the incremental cost-effectiveness ratio. The workshop aims to provide participants with a foundation for further developing CEA ideas and projects.
Sample size determination in clinical trials is considered from various ethical and practical perspectives. It is concluded that cost is a missing dimension and that the value of information is key.
Investing in specialised services - the prioritisation framework, pop up uni,...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Presentation by David Wonderling, Head of Health Economics at National Guideline Centre, Royal College of Physicians and Lauren Ramjee, Senior Health Economist, Royal College of Physicians.
This workshop outlines the principles of health economic evaluation for the NHS.
Getting started at the national level from demonstration to spreadProqualis
This document summarizes a presentation on implementing and scaling patient safety programs nationally in Scotland. It discusses how Scotland implemented a national patient safety program across all hospitals to reduce mortality and adverse events. Key points included establishing clear aims to reduce mortality by 15% and adverse events by 30%, implementing improvement programs in five areas, achieving significant reductions in outcomes like ventilator-associated pneumonia and central line infections, and creating the conditions for large-scale change through establishing aims, priorities, measurement, resources, and testing and spreading new learning.
The Challenge of Considering Costs while Caring for PatientsNeel Shah
This document discusses the challenge of considering healthcare costs while providing quality patient care. It notes that doctors need to avoid unnecessary tests and procedures in order to help control rising medical costs. The document outlines different payment models like fee-for-service that can incentivize overtreatment and suggests educating doctors on high-value care. It proposes reforming medical education to emphasize cost-effectiveness and providing resources to teach doctors how to consider costs without compromising patient outcomes.
Clearly identifies the root cause of skyrocketing health cost and what companies and employees can do to reduce cost of health care.
You will learn proven strategies used successfully to reduce company health cost for over 20 years.
The article analyzes the cost-effectiveness of a potential national rotavirus immunization program in the United States. It uses decision analysis to estimate the economic impacts and determine if such a program would be beneficial. The analysis considers costs such as physician visits, hospitalizations, and lost productivity due to rotavirus infections, and compares these to the costs of implementing a vaccination program. The conclusions will help inform healthcare policy by indicating whether a rotavirus immunization program should be adopted on a national level.
Valuing benefits: What value are we trying to capture? webinar
Thursday 25 January 2018
presented by Tim Goodspeed, morethanoutputs, Social value consultancy
hosted by Merv Wyeth, Benefits Management SIG Secretary
The link to the write up page and resources of this webinar:
https://www.apm.org.uk/news/valuing-benefits-what-value-are-we-trying-to-capture-webinar/
Twitter
#apmbenefits
@apmbmsig
Developing a World Leading Technology Enabled Health Programme of ResearchMaged N. Kamel Boulos
The document discusses developing a world-leading technology-enabled health research program by linking research to the real world. It notes current issues like the "mHealth app glut" and declining user interest due to a supply-demand mismatch. The proposed solution is to establish a partnership that brings together stakeholders from academia, healthcare providers, digital health industry, and the public. This partnership would use agile design methods, early and continuous user involvement, and evaluation approaches suited to digital interventions to develop solutions that meet real-world needs and ensure user acceptance. The goal is sustainable digital health programs through full engagement of stakeholders throughout the product lifecycle.
This document discusses cost-effectiveness analysis (CEA) and calculating the incremental cost-effectiveness ratio (ICER). There are 4 main types of CEA: cost-minimization analysis, CEA using natural units, cost-utility analysis using quality-adjusted life years (QALYs), and cost-benefit analysis using monetary units. The ICER is calculated as the incremental cost divided by the incremental effectiveness (e.g. cost per QALY gained) of a new intervention compared to the existing one. Key information needed includes outcomes and costs of both the existing and new interventions. An example ICER calculation for a new treatment for thingyitis is provided. Thresholds of willingness to pay per QAL
7. Tom Lewis Getting it right for pathology presentationPHEScreening
This document summarizes a presentation on the Getting It Right First Time (GIRFT) program and its workstream focused on pathology. GIRFT aims to reduce unwarranted variation in clinical care through data collection, identifying best practices, and promoting changes. The pathology workstream is led by four clinical leads and aims to measure current variability in pathology services, create a vision for the future, and test changes. Key activities will include collecting data through questionnaires and site visits to understand variations and identify opportunities for improvement.
This document discusses improving value in healthcare systems through a population health perspective. It provides examples of analyzing clinical pathways and interventions for conditions like COPD, stroke, and diabetes to identify high-value investments based on number of people treated, costs, and quality of life gains. The document emphasizes focusing resources on upstream prevention strategies rather than downstream treatment given evidence that prevention interventions provide much higher value per dollar spent at the population level.
Introduction to health economics for the medical practitionerDr Matt Boente MD
Against a background of increasing demands on limited resources, health economics is exerting an influence on decision making at all levels of health care. Health economics seeks to facilitate decision making by offering an explicit decision making framework based on the principle of efficiency. It is not the only consideration but it is an important one and practitioners will need to have an understanding of its basic principles and how it can impact on clinical decision making. This article reviews some of the basic principles of health economics and in particular economic evaluation.
This document summarizes discussions from a Health and Wellbeing Board (HWBB) on health inequalities in Sheffield. It outlines the context of health inequalities, how the city currently addresses the issue, evidence on effective interventions, and next steps. The key points are: the data shows inequalities have not improved in recent years; the current plan from 2014 still aligns with evidence but lacks program management; evidence points to addressing social determinants like poverty, education and employment; and the city needs to focus resources disproportionately to disadvantaged areas and populations to make meaningful progress on reducing inequalities.
This document discusses the complex factors that influence population health and how to improve health at the city level. It notes that health is determined by many social and environmental factors, not just access to healthcare. It advocates taking an approach that addresses the root causes of health inequalities and focuses on prevention rather than just treatment. Some key challenges mentioned include the complexity of issues, competing priorities, and political and commercial influences that can hinder upstream action.
A presentation to a National Institute of Health Research consultation event on identifying priorities for public health research for the next five years
This document provides information about Dr. Paul Cornes and his conflicts of interest. It discloses that Dr. Cornes receives salary from the UK National Health Service and has received honoraria from several pharmaceutical companies. The document then discusses challenges in setting reimbursement thresholds for new cancer treatments, including that many new drugs approved in 2012 cost over $100,000 annually but provided only small survival benefits. It also considers options for containing future health spending and the need to balance health spending with economic growth.
This document provides an introduction to economic and cost-effectiveness analyses in healthcare. It outlines four main types of analyses: cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. For each type of analysis, it describes how costs and health outcomes are considered. It also discusses important aspects like perspective, time frame, discounting, estimating costs, and identifying health outcomes. The goal is to help learners understand why economic analyses are relevant for health policy and research decisions.
1) Sovaldi (a Hepatitis C drug) was found to be cost-effective by NICE in the UK, but at £1 billion per year it is not affordable for the NHS if all eligible patients are treated. Other European countries have sought large discounts and imposed treatment caps to limit spending.
2) There are different ways to think about drug affordability - whether a cost is absolutely unaffordable, if payers need time to adjust spending, or if payers want to cap returns to "reasonable" levels through discounts.
3) Annualizing payments by charging for the drug's benefits over several years through amortization or annual fees is one way to address high upfront costs of
This document discusses cost-effectiveness analysis for evaluating health interventions. It defines efficacy versus effectiveness, and cost-effectiveness as assessing whether health improvements are worth the additional costs. The document outlines methods for cost-effectiveness analysis including identifying alternatives, measuring outcomes and costs, and using decision rules. Key points covered include measuring outcomes directly, considering both short and long term costs and benefits, and discounting future values.
Comparative Effectiveness: UCSF East Africa Global Health -Kisumu 2014GlobalResearchUCSF
The document describes an upcoming cost-effectiveness analysis workshop to be held in Kisumu, Kenya on January 20, 2014. The purpose of the workshop is to provide participants with a basic understanding of cost-effectiveness analysis concepts and methods and allow them to apply these concepts to an issue of their choosing. The workshop will cover core CEA approaches such as calculating incremental cost per standardized unit of health gain compared to alternative interventions and key metrics like the incremental cost-effectiveness ratio. The workshop aims to provide participants with a foundation for further developing CEA ideas and projects.
Sample size determination in clinical trials is considered from various ethical and practical perspectives. It is concluded that cost is a missing dimension and that the value of information is key.
Investing in specialised services - the prioritisation framework, pop up uni,...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Presentation by David Wonderling, Head of Health Economics at National Guideline Centre, Royal College of Physicians and Lauren Ramjee, Senior Health Economist, Royal College of Physicians.
This workshop outlines the principles of health economic evaluation for the NHS.
Getting started at the national level from demonstration to spreadProqualis
This document summarizes a presentation on implementing and scaling patient safety programs nationally in Scotland. It discusses how Scotland implemented a national patient safety program across all hospitals to reduce mortality and adverse events. Key points included establishing clear aims to reduce mortality by 15% and adverse events by 30%, implementing improvement programs in five areas, achieving significant reductions in outcomes like ventilator-associated pneumonia and central line infections, and creating the conditions for large-scale change through establishing aims, priorities, measurement, resources, and testing and spreading new learning.
The Challenge of Considering Costs while Caring for PatientsNeel Shah
This document discusses the challenge of considering healthcare costs while providing quality patient care. It notes that doctors need to avoid unnecessary tests and procedures in order to help control rising medical costs. The document outlines different payment models like fee-for-service that can incentivize overtreatment and suggests educating doctors on high-value care. It proposes reforming medical education to emphasize cost-effectiveness and providing resources to teach doctors how to consider costs without compromising patient outcomes.
Clearly identifies the root cause of skyrocketing health cost and what companies and employees can do to reduce cost of health care.
You will learn proven strategies used successfully to reduce company health cost for over 20 years.
The article analyzes the cost-effectiveness of a potential national rotavirus immunization program in the United States. It uses decision analysis to estimate the economic impacts and determine if such a program would be beneficial. The analysis considers costs such as physician visits, hospitalizations, and lost productivity due to rotavirus infections, and compares these to the costs of implementing a vaccination program. The conclusions will help inform healthcare policy by indicating whether a rotavirus immunization program should be adopted on a national level.
Valuing benefits: What value are we trying to capture? webinar
Thursday 25 January 2018
presented by Tim Goodspeed, morethanoutputs, Social value consultancy
hosted by Merv Wyeth, Benefits Management SIG Secretary
The link to the write up page and resources of this webinar:
https://www.apm.org.uk/news/valuing-benefits-what-value-are-we-trying-to-capture-webinar/
Twitter
#apmbenefits
@apmbmsig
Developing a World Leading Technology Enabled Health Programme of ResearchMaged N. Kamel Boulos
The document discusses developing a world-leading technology-enabled health research program by linking research to the real world. It notes current issues like the "mHealth app glut" and declining user interest due to a supply-demand mismatch. The proposed solution is to establish a partnership that brings together stakeholders from academia, healthcare providers, digital health industry, and the public. This partnership would use agile design methods, early and continuous user involvement, and evaluation approaches suited to digital interventions to develop solutions that meet real-world needs and ensure user acceptance. The goal is sustainable digital health programs through full engagement of stakeholders throughout the product lifecycle.
This document discusses cost-effectiveness analysis (CEA) and calculating the incremental cost-effectiveness ratio (ICER). There are 4 main types of CEA: cost-minimization analysis, CEA using natural units, cost-utility analysis using quality-adjusted life years (QALYs), and cost-benefit analysis using monetary units. The ICER is calculated as the incremental cost divided by the incremental effectiveness (e.g. cost per QALY gained) of a new intervention compared to the existing one. Key information needed includes outcomes and costs of both the existing and new interventions. An example ICER calculation for a new treatment for thingyitis is provided. Thresholds of willingness to pay per QAL
7. Tom Lewis Getting it right for pathology presentationPHEScreening
This document summarizes a presentation on the Getting It Right First Time (GIRFT) program and its workstream focused on pathology. GIRFT aims to reduce unwarranted variation in clinical care through data collection, identifying best practices, and promoting changes. The pathology workstream is led by four clinical leads and aims to measure current variability in pathology services, create a vision for the future, and test changes. Key activities will include collecting data through questionnaires and site visits to understand variations and identify opportunities for improvement.
This document discusses improving value in healthcare systems through a population health perspective. It provides examples of analyzing clinical pathways and interventions for conditions like COPD, stroke, and diabetes to identify high-value investments based on number of people treated, costs, and quality of life gains. The document emphasizes focusing resources on upstream prevention strategies rather than downstream treatment given evidence that prevention interventions provide much higher value per dollar spent at the population level.
Introduction to health economics for the medical practitionerDr Matt Boente MD
Against a background of increasing demands on limited resources, health economics is exerting an influence on decision making at all levels of health care. Health economics seeks to facilitate decision making by offering an explicit decision making framework based on the principle of efficiency. It is not the only consideration but it is an important one and practitioners will need to have an understanding of its basic principles and how it can impact on clinical decision making. This article reviews some of the basic principles of health economics and in particular economic evaluation.
This document summarizes discussions from a Health and Wellbeing Board (HWBB) on health inequalities in Sheffield. It outlines the context of health inequalities, how the city currently addresses the issue, evidence on effective interventions, and next steps. The key points are: the data shows inequalities have not improved in recent years; the current plan from 2014 still aligns with evidence but lacks program management; evidence points to addressing social determinants like poverty, education and employment; and the city needs to focus resources disproportionately to disadvantaged areas and populations to make meaningful progress on reducing inequalities.
This document discusses the complex factors that influence population health and how to improve health at the city level. It notes that health is determined by many social and environmental factors, not just access to healthcare. It advocates taking an approach that addresses the root causes of health inequalities and focuses on prevention rather than just treatment. Some key challenges mentioned include the complexity of issues, competing priorities, and political and commercial influences that can hinder upstream action.
the social determinants of mental illnessGreg Fell
This document discusses addressing the social determinants of mental illness and flipping the approach to mental health on its head. It makes four key points: (1) Most factors influencing mental well-being are outside the traditional health system; (2) Upstream social and economic factors matter more than downstream interventions; (3) All the proposed determinants are complex systems that interact; and (4) The default is to focus on symptoms over addressing root causes. It argues for a holistic, multi-sector approach to mental health that tackles issues like debt, employment, housing, and education.
the planning function does more for the cities HEALTH than the NHSGreg Fell
The director of public health in Sheffield argues that planning functions have a greater impact on city health than the National Health Service. They discuss how planning can address upstream causes of poor health like inequality, transport infrastructure, housing standards, and community design. The director emphasizes that planning should aim to create environments where health and well-being are the default and easiest options through green spaces, mixed developments, and walkable neighborhoods. They argue planners must consider health impacts and work to reduce health inequities through their decisions.
Using complex systems thinking to influence the way a city phe2018 gfGreg Fell
This document discusses using complex systems thinking to promote public health at the city level. It notes that health is determined by many interacting factors beyond just healthcare, and that addressing upstream social and economic determinants is important. It advocates taking a complex, long-term approach that considers many stakeholders and trade-offs rather than top-down policies. The goal is to set the system on a healthier trajectory rather than having perfect control or knowing all outcomes in advance.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
1 gf h econ slides basics
1. Everyday Health Economics
for Public Health
Greg Fell
Director of Public Health, Sheffield
@felly500 /
greg.fell@sheffield.gov.uk
2. Contents
1. Basics and introductory stuff
2. Cost effectiveness and ROI
3. Prevention
4. Better value in NHS and social care
3. Acknowledgements for slides
• Prof Chris McCabe
• Dr Chris Gibbons
• Prof Andrew Stevens
• Dr Peter Brambleby
• Prof Muir Gray
• Probably others…..
4. Learning Objectives -
• Basics of health economics. As
applied to health care and health.
• Overview of some theory, some
practical stuff in appraising cost
effectiveness studies, ins and outs of
ROI
• Tips to apply when arguing with folk
about value
5. Caveat
I am not an expert.
I know a little bit (well actually quite a lot,
comparatively) about HE but I am not an
economist and I have had lots of practice
translating all that clever economics.
6. Caveat (2)
The views below are not the views of my
employer or any of the agencies I have
worked with or for
7. Caveat (3)
I am assuming some basic
knowledge of the science of health
economics
This is NOT Health Economics 101
This is NOT a session in the basics
of HE
this is HE that textbooks wont teach
you
8. Caveat (4)
many of the examples here are pertinent
to health care.
Exactly same principles can be applied to
“prevention” or social care
11. • The Cancer programme budget in Bedford is
about £27.5m.
• If more funds are available next year what
would you spend more on (choose one):
• A: not on health care
• B: health care but not on cancer
• C: Cancer Prevention
• D: Diagnosis and treatment
• E: Supportive care for patients and carers?
Why?
12. • If the same budget was available next year,
but you could choose to spend in new ways,
would you spend more on (choose one):
• A: not on health care
• B: health care but not on cancer
• C: Cancer Prevention
• D: Diagnosis and treatment
• E: Supportive care for patients and carers?
Why?
13. • Since the less funds are available next year,
where would you spend less on (choose
one):
• A: not on health care
• B: health care but not on cancer
• C: Cancer Prevention
• D: Diagnosis and treatment
• E: Supportive care for patients and carers?
• F: Cant say or wont say
Why?
14. “A hellish decision is a choice you
have to make that clashes with
personal values, or has predictable
adverse impact on self or others.”
15. “The hottest places in hell are kept
for those who reserve judgement in
times of great crisis”. - JFK
16. Why do we spend so much on poor
value things??
Ash Paul (on twitter) asked me
over weekend something along
lines of "why do we spend so much
on cost ineffective stuff - like
telehealth, proton beam and robotic
surgery"
17. Why do we spend so much on poor
value things??
• my answer was (in 140 characters)
– indifference to overall cost among clinicians
– Moral hazard
– clinicians want to "do the best" for patients
– commercial interests / vested interests in
status quo
– stunning lack of understanding of incremental
cost effectiveness and how it plays out in the
real world....
which about sums up most of my daily life....
19. Why it matters that we spend a
lot on poor value stuff (beyond
the obvious answer of financial
and accounting)
20. The Don (not THAT Don) on the flat
of the curve
http://www.kingsfund.org.uk/audio-video/don-berwick-implementing-new-models-care
http://blogs.bmj.com/bmj/2015/03/23/richard-smith-flat-of-the-curve-healthcare/
Ever spiralling spend (is
normally on lower
value)
Crowds out more
valuable social
investments
Decent housing,
nutrition, education etc
21. Not just modelling
No economic ‘analysis’ – no literature,
costs or outcomes – HE helps to make
qualitative decision
Presentation of basic costs and/or effects
based on systematic review
Critical evaluation of existing economic
evaluation literature (3a: reverse
engineering of published analyses)
Original (de novo) economic modelling
1
2
3
4
Dr Chris Gibbons
23. The basic problem for the NHS
• You are the CCG Accountable Officer
• You have got an uplift in your budget of £1m
• It is recurrent.
• What should you invest in
– Neonatal intensive care – keeps 2 babies alive
– Approx 300,000 patients to be treated with statins who
were not previouly
– 30 patients to get the newest lung cancer drug that will
extend life by approx 4months per patient
– Better asthma inhalers for everyone
– That new indication for anti VEGF - 250 patients
– 10 salaried GPs.
– A new urgent care centre
Back to contents
24. The basic problem for Local Govt
• You are the LA Chief Exec
• You continue to stare down the barrel of austerity
• What should you disinvest in
– Childrens social care – helps keep children safe and
out of care system
– Home care – helps people stay safe, well and
independent
– Road maintanence budget.
– Selective licencing programme – directly impacting on
housing safety and quality in private rented sector
– Infrastructure in community and voluntary sector.
Provides backbone of social prescribing.
Back to contents
25. Economics in 3 lines
Dr Richard Richards, Assistant Director of Public Health
1. Resources are always scarce
2. Therefore choices have to be made
3. Every choice represents a lost opportunity to
do something else
• We ration organs very carefully indeed.
Organs are scarce, therefore difficult decisions
need to be made about how to allocate. This is
no different to allocating finances to different
competing health care programmes
26. important lessons from
economic theory
1. Diminishing marginal returns
2. Average v incremental
3. Opportunity cost
4. Priority setting
5. Population impact
6. Innovation and shiny toys
29. Average cost of picking up Colon Cancer through
screening - FOBT. US study. American Cancer Society.
no of rounds to try to pick up. total cases detected total costs average costs per case detected
1 65.9 77,511.0 1,175.5
2 71.4 107,690.0 1,507.4
3 71.9 130,199.0 1,810.8
4 71.9 148,116.0 2,058.9
5 71.9 163,141.0 2,267.7
6 71.9 176,331.0 2,451.0
Back to contentsBack to intro and basic concepts
30. But what if we look at the marginal cost of additional
testing rounds for picking up more cases
no of tests
Marginal benefit of the additional
test (number of additional
cases picked up
marginal costs (of
additional test) Marginal cost per case detected
1 65.9 77,511.0 1,175.5
2 5.5 30,179.0 5,487.1
3 0.5 22,509.0 48,932.6
4 0.0 17,917.0 465,376.6
5 0.0 15,025.0 4,695,312.5
6 0.0 13,190.0 43,966,666.7
use the term marginal to refer to the fact that we rarely start from scratch / a blank sheet.
More often we are concerned with the question 'what is the value of adding or removing one or more
components' in terms of the added outcome.
thus in the example above, one round of screening test will pick up 65 cases, at a marginal cost per
case of 1175
6 rounds will pick up 72 cases at marginal cost per case of 43m…..
31. no of
roun
ds to
try to
pick
up.
total cases
detec
ted total costs
average
costs
per
case
detec
ted
Marginal benefit
of the
additional
test
(number of
additional
cases
picked up
marginal costs
(of
additional
test)
Marginal cost per
case detected
1 65.9 77,511.00 1,175.50 65.9 77,511.00 1,175.50
2 71.4 107,690.00 1,507.40 5.5 30,179.00 5,487.10
3 71.9 130,199.00 1,810.80 0.5 22,509.00 48,932.60
4 71.9 148,116.00 2,058.90 0 17,917.00 465,376.60
5 71.9 163,141.00 2,267.70 0 15,025.00 4,695,312.50
6 71.9 176,331.00 2,451.00 0 13,190.00 43,966,666.70
New COPD drug.
Add into coctail of drug for treating unstable COPD.
What is the incremental cost and incremental effectiveness (?reduction in
acute admits) from adding this drug into a treatment regimen.
32. IVF no of cycles in QALYs
Duncan Cooper
NICE IVF CG 2013
33. And in metrics that are more
readily understood
Duncan Cooper
NICE IVF CG 2013
34. Opportunity cost
The opportunity cost of any
choice is the value of the best
alternative choice that you
have to sacrifice in order to
pay for it
35. Locally we fund ONE cycle of IVF
• NICE recommend 3
• We fund 1.
• Opportunity cost of moving to 3 cycle IVF = £0.5m
• 100 PPCI
• 8 midwives
• 30% increase in funding to stop smoking services
• 16 classroom assistants
• Every investment should be considered in the
context of the commensurate service that will be
displaced.
36. An aside – but an important one
as it burns your budgets like
theres no tomorrow
Innovation – old innovations, new
innovations.
Paying for innovation
technical (biotech/pharma/IT / AI / genomics)
service-level
knowledge-driven (ie changing how we think)
37. Here are two definitions.
• a) From “shiny new thing”. usually, but not
always involves new technology.
• b) To disruption in the established way of
doing things that improves population
relevant and / or individual outcomes in a
way that is cost saving, cost neutral or
objectively cost effective from a
commissioner viewpoint.
38. We spend a vast sum on “innovation”
in the hope of solving problems
here is the story of the curious case
of the Bradford Robot…..
39. Example The Da Vinci Robot.
• New?
• Radical?
• Game changing?
• c£2m fixed cost, £1500 per
procedure expendables.
• Of course you should
expect good evidence of
substantial improvement in
prostate cancer survival
and reduced medium term
complications
40. There is no such evidence.
There is US evidence that the existence of
“the robot” is influencing patient decisions
more towards radical prostatectomy when
those same patients might have
historically elected for watchful waiting
(with no poorer outcomes as a result)
41. All that glitters is not gold
Conclusions and Relevance During its initial national
diffusion, MIRP was associated with diminished perioperative
patient safety. To promote safety and protect patients, the
processes by which surgical innovations disseminate into
clinical practice require refinement.
43. It kind of, sort of, works out at
annual volume n=150 or so
see p71
more costly, slightly more
QALYs (tho no survival benefit,
assumed survival based on
modelled data about margin of
removal), HIGHLY sensitive to
cost, which is highly sensitive
to volume done (sweating
asset)
44. And it is now NICE recommended –
if n=150
Commissioners should ensure that robotic systems for the surgical treatment of localised
prostate cancer are cost effective by basing them in centres that are expected to perform at
least 150 robot-assisted laparoscopic radical prostatectomies per year. [new 2014]
45. What is “n” in your local centre?
Has your local centre thought about
fixed and variable costs.
Have you thought about payments
and tariff.
46. A Da Vinci robot is £2m capital +
tariff uplift on consumables
47. Hip Arthroscopy
• Impingement or labral tear
• Alternatives are pain management physio or
replacement
• NICE IPG – poor quality evidence but enough
to recommend. Taken as green light.
• HA = £3.5k (JRS = £5k)
• In 2017 RCT – improvement in pain scores of
6 points (0-100 scale) against physio.
• Worth it?
48. Some further examples of innovations
• Primary PCI
• Thrombolysis in stroke
• Telemedicine and Telehealth
• Assisted living technology
• Expensive new lipid agents PSK9s
• Renal denervation for resistant
hypertension
49. Shiny things take £ and distract
attention
• ……..from the things that make MOST difference
– Speed of PPCI / system to sort this
– stroke thrombolytics & HASU vs primary prev
– Aggressive implementation of lifestyle intervention – stop
smoking!
– Telestuff – evidence and system in which you drop the telestuff is
chaotic
– Optimisation of medicine in Heart Failure patients!
– 10% risk vs under statinisation of high risk
50. The areas where we have
TRANSFORMED outcomes in last
20 years
• Cancer
• CVD
• Renal?
• System development
• National standards. Relentlessly
implemented. Standardised approach
• Products have helped. Systems have
MATTERED
51. Paying for innovation
• From lower value interventions in the
same programme area. PBMA
• Period.
• Unfair that glaucoma patients pay for
innovation (by rote of poorer care /
services / lack of investment) as a result of
req to invest in AMD
• Unfair that asthma patients pay as a result
of requirement to invest in Cancer care
53. Oh really? • is enalapril + 10mg TD dose etc
the best comparator in this group,
• composite outcomes - all the
normal statistical jiggery pokery
that goes with them
• powered to detect difference in
composite outcome
• 5 odd % abs risk difference
(ARD) NNT = 20, but this is the
composite
• c3% ARD in deaths (power?), but
of the deaths a relatively low %
from CVD causes....
• risk of hospitalization reduced by
21%
• this is a relative risk- that will be
misplayed in the marketing spin.
ARD please??
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1409077
56. Epidemiology
• Incidence / prevalence
• is it a first line thing.... in which case
incidence important
• or a "in the pathway" thing... in which case I
and P important
• which sub groups, or all
57. • What is the PICO
• Incremental effectivness and cost. Including
implementation costs
• compared to what
• NNT / ARD - risks and benefits
• time frame
• Perspective – cost and return to who
• common sense - does the clinical and cost data
feel like the real world
58. Five handy questions to ask the
Professor
• Do you believe that NHS is cash limited
• Do you think there should be objective
evidence that benefit outweigh harm prior to
introduction
• Do you believe that should be objective
evidence re cost effective prior to intro
• Are you okay that others will be denied care if
the evidence suggests that the introduction of
the treatment is a net cost for the nhs
• Can you identify which group you'd like to
deny the care of
59. The “This is cost saving”
business case
If I had a pound for every time….
5 things to say
60. “this is cost saving”
A note on ‘invest to save’ proposals
• The world is full of proposals that start with ‘if only we made this
investment, then we could save’. The savings rarely come to
fruition. Reality of assumptions, differential timing of investment
and savings complicates further. Doesn’t address the
fundamental problem. Unmet need.
• ‘Invest to save’ proposals only if:
1. clear and good q evidence re clinical and cost
effectiveness - it could work
2. Clear business case demonstrating is HAS worked
somewhere else
3. Clear proposal - applying Population, intervention,
Comparator, outcome
4. Management capacity and the right incentives and levers
to actually make it work
5. A clear plan for realizing any savings in hard cash
61. “But its an effective treatment, you
MUST pay for it”
Five questions to ask
1. Do you believe that NHS is cash limited
2. Do you think there should be objective evidence that
benefit outweigh harm prior to introduction
3. Do you believe that should be objective evidence re cost
effective prior to intro
4. Are you okay that others will be denied care if the
evidence suggests that the introduction of the treatment is
a net cost for the NHS
5. Can you identify which group you'd like to deny the care of
62. Innovation and economics. The
opportunity cost of innovation
JAMA November 26, 2014 Volume 312, Number 20
Do good
First do no harm
Yes of course
What about the harm done
to those that bear the
opportunity cost of
marginal benefit high cost
innovations
http://newsatjama.jama.com/2014/09/17/jama-forum-high-tech-care-can-save-lives-but-it-also-may-
create-incentives-that-result-in-lives-lost/
64. Ticagrelor
• Effective
• Highly cost
effective – c£2,500
/ QALY
• NICE TA approved
in Unstable Angina
and MI
• NNT – CV Death
c55
• The new clopidogrel
• The new (new)
aspirin
65. Int J Clin Pract, November 2013, 67, 11, 1210–1212
Gain in life expectancy?
CV events?
CV mortality ?
66. • The evidence that it is better in UA is equivocal.
– Forrest plot - page 654 of the online supplementary
appendix
• It is better than clopidogrel in MI.
• Implementing this medicine in the UA / MI population
will cost Bradford B&A c£1m
• 5 less deaths
• It will shift crude CV mortality from 2.37 / 1000
registered pop to 2.36 / 1000.
• And add 0.02y to life expectancy.
• So it is innovative, effective and highly cost
effective…..but does it make a difference to
population relevant outcomes.
• And is it worth it.
67. Population impact of Herceptin
• 5.5 days of added life in women
• At £182m
Richard Richards
68. “But its not fair to measure whole
pop outcomes – only in the treated
pop”
• It should be only impact in those treated
with that thing
• Yes sure
• But it's the pop more broadly that bear the
opportunity cost
• is that fair?
• Which is least unfair?
71. Fundamental principles of priority setting
1. Prioritization will be adopted as the methodology for
decision making (often referred to within commissioning
organizations as the ‘primary of prioritization’)
2. Stay within budget
3. Only invest in treatments which are cost-effective
4. Optimize health gain
5. Do not allow third parties to dictate priorities
6. Do not fund one individual if others with the same clinical
need cannot be funded
7. Do not fund treatments of unproven clinical effectiveness
unless it is in the context of well-designed clinical study
8. Social factors should not be taken into account at the
level of the individual
Daphne Austin IDEAL
72. The theory of priorities Vs the practice
– disinvestment this time.
Decisions about whether to decommission
services may be based largely on cost and
government intervention rather than
effectiveness, safety and cost-effectiveness.
principles by themselves won't get you out of a fix
doi:10.1186/s13012-014-0123-y