Seminar:Understanding the underutilisation of evidence from economic evaluations in healthcare: a mixed methods design. Speaker: Gregory Merlo, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Australia.
Pharmacovigilance and Materiovigilance, Drugs and Cosmetics Actshashi sinha
Due to side effects of Medicines and Medical Devices increasing day by day it is important to monitor the Adverse Events arising out of use of Medicines and Medical Devices. The Pharmacovigilance and Materiovigilance monitors adverse events arising our of usage of Drugs and Medical Devices respectively. This chapter also deals with Drugs and Cosmetics Act 1940 and their important provisions.
Pharmacovigilance and Materiovigilance, Drugs and Cosmetics Actshashi sinha
Due to side effects of Medicines and Medical Devices increasing day by day it is important to monitor the Adverse Events arising out of use of Medicines and Medical Devices. The Pharmacovigilance and Materiovigilance monitors adverse events arising our of usage of Drugs and Medical Devices respectively. This chapter also deals with Drugs and Cosmetics Act 1940 and their important provisions.
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
OHE’s Professor Nancy Devlin has researched, written and spoken widely on the use of the EQ-5D, and related measures, both in her capacity as the Director of Research at the OHE and as Chair of the Executive Committee of the EuroQol Group.
In May, Nancy was invited to participate in the “Workshop on measuring patient-reported outcomes using the EQ-5D”, which was organised by the Swedish National Board of Health and Welfare in collaboration with the EuroQol Group. The workshop brought together policy makers and researchers in Sweden interested in measuring patients’ health outcomes.
Sweden has included the EQ-5D in some of its quality registries and in population health surveys for many years. The Swedish National Board of Health and Welfare now is exploring whether and how to extend use of patient reported outcomes measures in the health care system, including the EQ-5D, to both monitor the quality of providers and services and to facilitate health technology appraisal.
Nancy’s talk, shown below, introduced the EQ-5D instrument; discussed how data from it can be analysed; identified some of the challenges in analysis; and commented on the future of outcomes measurement.
Technologies that enhance the precision and effect of therapies can make a critical contribution to ensuring value for money and improving patient care. Methods and processes for assessing value, however, still are imperfect. This presentation reviews the challenges and identifies some approaches for meeting them.
Health outcomes research is seen as a cost-effective investment in measuring and defining value of new innovations in health care. We provide an overview of field and its applications
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Public private partnerships in healthcare. Evaluation of 10 years´ experience...Antonio Clemente Collado
Doctoral Thesis based in a performance model to compare the outcome of PPPs hospitals vs public managed ones. This study integrates the cost and also quality variable to point the strengths and weaknesses of both management models.
> Why HEOR?
> Costs, Consequences and Perspectives
> Key Stakeholders in HEOR
> What is Health Economics and Pharmaco-economic Research?
> Economic Evaluations
> Incremental Cost Effectiveness Ratio (ICER)
> Concept of HRQoL
> Comparative Effectiveness Research (CER)
> Pragmatic Clinical Trials
> Observational Studies
> Systematic Reviews and Meta-Analysis
> Application of CER
> Health Technology Assessment (HTA)
> Real World Evidence (RWE)
> Patient Reported Outcomes (PROs)
> Patient Focused Drug Development (PFDD)
> Application of Health Economic Evaluations
> Challenges and Barriers
OHE’s Professor Nancy Devlin has researched, written and spoken widely on the use of the EQ-5D, and related measures, both in her capacity as the Director of Research at the OHE and as Chair of the Executive Committee of the EuroQol Group.
In May, Nancy was invited to participate in the “Workshop on measuring patient-reported outcomes using the EQ-5D”, which was organised by the Swedish National Board of Health and Welfare in collaboration with the EuroQol Group. The workshop brought together policy makers and researchers in Sweden interested in measuring patients’ health outcomes.
Sweden has included the EQ-5D in some of its quality registries and in population health surveys for many years. The Swedish National Board of Health and Welfare now is exploring whether and how to extend use of patient reported outcomes measures in the health care system, including the EQ-5D, to both monitor the quality of providers and services and to facilitate health technology appraisal.
Nancy’s talk, shown below, introduced the EQ-5D instrument; discussed how data from it can be analysed; identified some of the challenges in analysis; and commented on the future of outcomes measurement.
Technologies that enhance the precision and effect of therapies can make a critical contribution to ensuring value for money and improving patient care. Methods and processes for assessing value, however, still are imperfect. This presentation reviews the challenges and identifies some approaches for meeting them.
Health outcomes research is seen as a cost-effective investment in measuring and defining value of new innovations in health care. We provide an overview of field and its applications
An Introduction Patient Reported Outcome Measures (PROMS)Keith Meadows
An introduction to the key concepts of patient Reported Outcome Measures, including reliability and validity, generic versus disease specific,selection criteria and their adaptation for different cultural groups.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Public private partnerships in healthcare. Evaluation of 10 years´ experience...Antonio Clemente Collado
Doctoral Thesis based in a performance model to compare the outcome of PPPs hospitals vs public managed ones. This study integrates the cost and also quality variable to point the strengths and weaknesses of both management models.
Measuring and Evaluating Reproductive Health Initiatives MEASURE Evaluation
This presentation provides an overview of the process of updating the Compendium of Indicators for Evaluating Reproductive Health Programs and what the final product will include.
Jack Hazerjian's presentation from the Measuring Success Toolkit webinar in September 2012. This PowerPoint is available for download, and the explanatory notes are visible below.
Performance of Routine Information System Management Framework (PRISM) led by Natasha Kanagat
The PRISM framework consists of four tools to assess Routine Health Information System (RHIS) performance, identify technical, behavioral and organizational factors that affect RHIS, aid in designing priority interventions to improve performance and improve quality and use of routine health data.
Recording: http://universityofnc.adobeconnect.com/p1edhgz9zs7/
PRISM Tool: https://www.cpc.unc.edu/measure/publications/ms-11-46-d
The 7 Steps to Improve HIV/AIDS Programs Guide presents concrete steps and illustrative examples that can be used to facilitate the use of information as a part of the decision-making processes guiding program design, management and service provision in the health sector. Download 7 Steps to Improve HIV/AIDS Programs Guide.
Tool: http://www.cpc.unc.edu/measure/publications/ms-11-46-b
Webinar Recording: http://universityofnc.adobeconnect.com/p5msoue5e67/
Looking at implementation: how useful is realist evaluation?valéry ridde
Presentation by Emilie Robert (McGill University).
Global Health Workshop: Methods For Implementation Science in Global Health.
http://www.equitesante.org/implementation-science-methods-in-global-health/
Researching Purchasing to achieve the promise of Universal Health Coverageresyst
This presentation was given by Professor Kara Hanson at the BMC Health Services Research Conference, in July 2014.
The presentation illustrates the important role that strategic purchasing can play in achieving effective health coverage, and how the topic is being studied by researchers. It highlights RESYST's multi-country study of purchasing arrangements that is currently taking place in Nigeria, Kenya, Tanzania, South Africa, India, Thailand and Vietnam.
This presentation by the Bureau of Health Information to the Royal Australasian College of Physicians looks at using clinical outcome data to improve patient care.
It examines:
Why measure and report on performance?
- Accountability and quality improvement
What is performance really?
- It is not a measure of what the system is, it is a measure of how well the system does
Whose performance is it anyway?
- Attributing results to providers, units or sectors requires a careful assessment
Remote monitoring: Direction for ResearchMarc Lange
Remote monitoring will happen! Integrating ICT in health care is about progress and who can stop the progress?
Also, patients are about to demand for it. Have in mind their current interest for mHealth and note that in a large number of trials, the feedback received from patients and their carer is positive: they feel more secure when receiving feedback on the data they sent remotely and if attention has been paid to educate them in interpreting the data they are sending, they can become a full partner of the care team!
Finally, remote monitoring services – combined with self-care – offer strategic opportunities to modernise health care systems by enabling them to become more proactive, better empower patients and citizens and, in the end, use health care resources more efficiently.
To identify future directions for research, this lecture will consider remote monitoring from three viewpoints: what evidence is still needed, how best to support decision making in favour of doing remote monitoring, and how best to support the deployment of remote monitoring in routine care. Results and lessons learned from two European Commission co-financed projects, Renewing Health and United4Health , will be used to illustrate the messages.
Do height and BMI affect human capital formation? Natural experimental evidence from DNA. CHE seminar presentation by Neil Davies, University of Bristol 12 June 2020
Healthy Minds: A Randomised Controlled Trial to Evaluate PHSE Curriculum Deve...cheweb1
CHE Seminar presentation 16 January 2020, Alistair McGuire, Department of Health Policy, LSE. Evaluating the Healthy Minds program: The impact on adolescent’s health related quality of life of a change in a school curriculum
Baker what to do when people disagree che york seminar jan 2019 v2cheweb1
Public values, plurality and health care resource allocation: What should we do when people disagree? (..and should economists care about reasons as well as choices?) CHE Seminar 21 January 2019
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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).
Getting evidence from economic evaluation into healthcare practice
1. Getting evidence from economic
evaluation into healthcare practice
Gregory Merlo
Supervisors: Dr Page, Dr Halton, Prof
Graves
2. Centre of Research Excellence in Reducing
Healthcare Associated Infections (CRE-
RHAI)
Focused on developing and evaluating innovative,
cost-effective, strategies to reduce healthcare
associated infections in Australia.
The CRE includes a diverse group of researchers
from clinical and academic fields, working together
on projects that will translate into improved
infection control decisions at clinical and policy
level.
www.cre-rhai.org.au
3. Good use of economic evaluation
Transparent and fair analysis of the opportunity
cost of a decision
Engagement with stakeholders
Measuring good use
• “supply” and “demand”
• Influence on outcomes or processes
4. Poor use of economic evaluation
• Evidence shopping
• Evidence suppression
• Making sure to get the “right” result
• Misuse due to misunderstanding
5. Political context
Economic evaluations are commissioned within
a political context
– Pharmaceutical Benefits Advisory Committee
(PBAC)
– Health services research in Australia
• National Hand Hygiene Initiative
– Academic imperatives
6. Getting economic evaluation into
practice
Goal: Articulate best practice for getting
economic evaluation into practice
Consistent with good use of evidence!
7. Getting economic evaluation into
practice
1. Identify the factors that determine the use of
evidence from economic evaluations in
healthcare decision making
– Literature
2. Determine the relative importance of these
factors to healthcare decision makers
– Discrete choice experiment
3. Identify the strategies used by health
economists to address these factors
– Qualitative interviews
8. Getting economic evaluation into
practice
1. Identify the factors that determine the use of
evidence from economic evaluations in
healthcare decision making
– Literature
2. Determine the relative importance of these
factors to healthcare decision makers
– Discrete choice experiment
3. Identify the strategies used by health
economists to address these factors
– Qualitative interviews
9. Literature review
• Searched EMBASE using synonyms for
“economic evaluation” and “decision making”
• Inclusion criteria
– Peer-reviewed journal articles
– Reporting the perceived barriers and facilitators to
using evidence from economic evaluation in
healthcare decision-making
– In English
10. Literature review
• 45 studies met eligibility
• 16 surveys, 21 interviews , 3 focus groups, 10
observation of meetings
• Stakeholders: doctors, pharmacists, hospital
administrators, bureaucrats, HTA organisations
• Settings: North America, Europe, Asia and
Australia
12. Accessibility
Timely access to relevant research that is
understandable.
• Absence of relevant economic evaluations
• Time and cost of research
• Time to access
• Poor awareness of current evaluations
13. Accessibility - understanding
• Lack of training
• Language complexity
• Design complexity
• Variation in methods and presentation
15. Scientific acceptability
• Poor quality of research informing economic
evaluations
• Concerns with methods
– QALYs, measuring indirect and overhead costs,
modelling assumptions, appropriateness of CE
threshold
• Conflicts of interest
16. Institutional acceptability
Does the evaluation meet institutional needs?
• Transferring resources and adjusting budgets
• Narrow scope (HR decisions)
• Not specific
• Disinvestment
• Potential economic benefits not being realised
17. Ethical acceptability
• Acceptance of explicit rationing
– Individual (doctor-patient) ethic vs population
ethic
• Excuse for cost cutting
• Evaluations rarely analyse equity impact
18. Accessibility - strategies
• Simplify language and analysis methods
• Standard formats for presenting economic
evaluations (CRD programme)
• Training
• Economic evaluation databases
– National Health Service Economic Evaluation
Database
19. Scientific acceptability - strategies
• Good practice guidelines
• Improving quality of clinical evidence
• Reporting conflicts of interest
20. Institutional acceptability – strategies
• Involving all stakeholders
– Increasing relevance of evaluations
• Flexible budgets
• Incorporating budget and resource allocation
constraints
• Demonstrating direct benefit to the
administrator or department
22. Getting economic evaluation into
practice
1. Identify the factors that determine the use of
evidence from economic evaluations in
healthcare decision making
– Literature
2. Determine the relative importance of these
factors to healthcare decision makers
– Discrete choice experiment
3. Identify the strategies used by health
economists to address these factors
– Qualitative interviews
23. Discrete choice experiment
We use discrete choice experiments to
determine the aspects of services that people
value
What if we treat an economic evaluation as a
service?
24. Discrete choice experiment
• Designed to elicit stakeholder preferences for
economic evaluation
• Stakeholders: healthcare professionals, health
administrator/manager, health researchers
• Attributes represent the distinguishing
features of the economic evaluation
25. Scenario
Participants have to choose between two health
economists who will provide cost effectiveness
evidence to assist in making a decision to
purchase a piece of equipment for the hospital.
The attributes will be the features that
distinguish these two health economists
26. Identification of attributes
Accessibility
Length of time Communication
Health economics training Complexity of methods
Acceptability (scientific)
Quality of clinical evidence Quality of economic modelling
Conflict of interest Assumptions and sources stated
Acceptability (Institutional)
Applicability More flexible budgets
All relevant stakeholder involved Budget impact / resource allocation
Acceptability (ethical)
Reporting equity Incorporating clinical need
27. Identification of attributes
Accessibility
Length of time Communication
Health economics training Complexity of methods
Acceptability (scientific)
Quality of clinical evidence Quality of economic modelling
Conflict of interest Assumptions and sources stated
Acceptability (Institutional)
Applicability More flexible budgets
All relevant stakeholder involved Budget impact / resource allocation
Acceptability (ethical)
Reporting equity Incorporating clinical need
Scoping survey
(N=35)
28. Identification of attributes
Accessibility
Length of time Communication
Acceptability (scientific)
Quality of clinical evidence Quality of economic modelling
Conflict of interest
Acceptability (Institutional)
Applicability
Acceptability (ethical)
Reporting equity
Scoping survey
(N=35)
29.
30. Levels
Quality of clinical evidence
– Good, fair, poor (risk that bias, confounding,
chance influenced results)
Quality of economic modeling
– Good, fair, poor (accuracy given clinical evidence)
Length of time
– 1 month, 6 months, 12 months
31. Levels
Communication (how easy to understand,
unnecessary complexity)
– Good, fair, poor
Equity (potential costs and consequences across
socioeconomic groups)
– Thorough analysis, mentioned, no consideration
32. Levels
Applicability (to decision making context –
hospital, department or other)
– Specifically applied, Generally applied, not applied
Conflict of interest
– No conflict, independent with industry funding,
employed by industry
33. Discrete choice design
• Forced choice
• Unlabeled (“Economist A”, “Economist B”)
• Orthogonal fractional factorial design in
NGENE
• Two blocks of nine choice sets (+ repeat)
34. Administering survey
Piloted (N=15) for validity, readability, and applicability
Online (Keysurvey)
Recruitment through professional contacts and mailing
lists.
Demographic and attitudinal questions
35. Analysis
Preferences were analysed using conditional (fixed-
effects) logistic regression
Time was continuously coded (in months)
Other attributes were effects coded.
Time attribute used to calculate willingness to wait
36. Participants
94 accessed survey and answered all ten choice
comparisons
• 67% female
39%
35%
17%
5%
3% Health researcher
Health professional
Health
manager/administrator
Healthcare professional
and researcher
Healthcare professional
and manager/adminstrator
37. Experience and attitudes regarding
economic evaluation
42% had received training in economic evaluation
(often a single or multi-day course)
17% had worked on an economic evaluation
32% had worked with a health economist
58% at least sometimes used cost effectiveness
evidence in decision making
38. Results
Conditional logistic regression revealed a good
model fit (McFadden’s pseudo R2 = 0.257)
Interaction terms not significant
Significant preference for all attributes except
reporting equity
39. Attribute Level Mean parameter (95% CI)
Quality of clinical
evidence
Fair 0.24 ( 0.05, 0.44)
Good 0.71 ( 0.40, 1.02)
Quality of economic
modelling
Fair -0.12 (-0.34, 0.10)
Good 1.14 ( 0.86, 1.42)
Length of time Per 1 month -0.06 (-0.03, -0.09)
Communication Fair -0.44 (-0.69,-0.19)
Good 0.82 (0.48, 1.16)
Equity Mentioned -0.05 (-0.22, 0.13)
Thorough analysis 0.19 (-0.02, 0.41)
Applicability Generally applied to context 0.48 (0.28, 0.68)
Specifically applied to context 0.59 (0.39, 0.79)
Conflict of interest Independent with industry
funding -0.01 (-0.23, 0.21)
No conflict 0.75 (0.51, 0.99)
40.
41.
42.
43. DCE key messages
There is a clear preference for economic evaluations to be
good quality, and communicated well by a researcher
without conflicts of interest.
Methodological rigour was valued, but didn’t dominate.
Stakeholders were willing to trade rigour.
Stakeholders willing to wait for an economic evaluation
that met their needs.
44. Getting economic evaluation into
practice
1. Identify the factors that determine the use of
evidence from economic evaluations in
healthcare decision making
– Literature
2. Determine the relative importance of these
factors to healthcare decision makers
– Discrete choice experiment
3. Identify the strategies used by health
economists to address these factors
– Qualitative interviews
46. Questions
Case example of recent economic evaluation
(context)
How can we improve the way economic
evaluations are produced?
What can researchers do to help users of
evidence from economic evaluations?
47. Participants
ID Country Description
HE1, HE2 Australia Health economics professor
HE3 Australia Health economist and senior research
fellow
HE4, HE5 UK Health economics professor
HE6, HE7 UK NICE guidelines, technological appraisal
Local health authorities (HE7)
HE8 UK Trial based economic evaluation
49. Contexts
Australia
• Health services research
• Technology appraisal
UK
• NICE clinical practice guidelines
• NICE technology appraisals
• Local authorities
• Trial-based (economic evaluation)
51. Accessibility
In all cases the evaluation didn’t exist before
Why commissioned?
• Organisation making a decision
• Clinical trial underway
• Clinical practice guidelines
• Academic driven
52. Accessibility
Formats of the economic evaluation
• Formal report
• Presentation to group
• Summary document (sometimes)
• Dissemination
– Manuscript
– Conferences
– Social media (not mentioned in interviews)
– Collaborators as advocates
54. Accessibility - Understanding
Complexity
– Parsimony
– Appropriate language
– You don’t have to report everything
“Do uncertainty and scenario analysis so you've got that
information there but not necessarily presenting all of
that” [HE3]
Telling the story
55. Scientific acceptability
• “Get published in a high impact journal” [HE1]
• Scientific rigour (“defendable and justifiable”
[HE2] )
• Expertise
• Qualifications
• Professionalism
• Bundling: Guidelines, governmental report
• Credibility of field: CE threshold
56. Institutional acceptability
Quality of the collaboration
“You really want your question to be driven by people in practice and
something that's a relevant problem.” [HE2]
“If you just turn up to strangers and say "this is what I think you should do", I
don't think the paper is going to change their thinking that much.” [HE1]
57. Institutional acceptability
Collaborators’ knowledge of changing trends
“…people who not only now current clinical practice but who are quite on the
edge of clinical practice so that they know how things are changing over
time.” [HE2]
Inconvenient results
59. Key messages
Already seeing something different
• Familiarity with concepts (CE thresholds,
MCDA)
• Taken for granted (professionalism)
60. Conclusion
Multiple factors influence accessibility and
acceptability
– Not all equally important.
Factors perceived differently by producers and
users
Editor's Notes
I searched EMBASE to find peer-reviewed journal articles that reported the perceived barriers and facilitators to using evidence from economic evaluation in healthcare decision-making.
42 studies met eligibility, including surveys, interviews, focus groups, and observational studies. Opinions were gathered from decision makers with quite different professional and national backgrounds. They generally regarded economic evaluations favourably. But even with their favourable attitudes, they didn’t use economic evaluations very often. Remarkably, the studies all reported many of the same barriers to using economic evaluations.
The conditional logistic regression model revealed a good model fit.
The β-coefficients of the model, representing the preference weights associated with the attributes are presented here.
The preference of either fair or good quality evidence over poor quality evidence was significant
For both economic modelling and communication, good quality was preferred over poor but fair quality was not significantly preferred over poor.
Similarly, there was a significant preference for having no conflict of interest but there was no significant difference in preferences between working directly for industry compared with being an independent researcher receiving industry funding
Respondents preferred economic evaluations that were either generally or specifically applicable to evaluations that were not applicable
There was a significant preference for having a shorter time to wait until the completion of the economic evaluation.
Preferences for either mentioning possible equity impacts (β=-0.05, 95% CI -0.22, 0.13) or doing a thorough analysis of equity impact (β=0.19, 95% CI -0.02, 0.41) were not significantly preferred over not discussing equity
There was no significant effect on the model associated with the stakeholders’ profession, gender, or previous training with economic evaluation
The greatest willingness to wait was for good quality economic modelling (19.8 months), good communication (14.9 months), avoiding conflicts of interest (12.9 months), and good quality evidence (11.3 months). Respondents were also willing to wait almost a year to make sure that the evidence is generally (8.3 months) or specifically (10.1 months) applicable to their clinical context. They were willing to wait almost a third of a year (3.7 months) to have at least fair quality clinical evidence.