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The company aims to deliver an innovative, low-cost colonoscopy solution called EndoNav's RigiFlexTM disposable Over-the-Scope (OTS) device that eliminates the need for painful sedation and increases procedure throughput. The solution addresses problems with traditional colonoscopy scopes that cause looping and damage to the colon. It is estimated to decrease procedure time, increase revenue, reduce complications, and have a shorter learning curve for physicians. Financial projections estimate the company will have positive net income within 3 years and an overall internal rate of return of 99%.
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The company aims to deliver an innovative, low-cost colonoscopy solution called EndoNav's RigiFlexTM disposable Over-the-Scope (OTS) device that eliminates the need for painful sedation and increases procedure throughput. The solution addresses problems with traditional colonoscopy scopes that cause looping and damage to the colon. It is estimated to decrease procedure time, increase revenue, reduce complications, and have a shorter learning curve for physicians. Financial projections estimate the company will have positive net income within 3 years and an overall internal rate of return of 99%.
This document discusses how Irish hospitals can benefit from benchmarking. It provides background on cost per patient benchmarking in the Dutch DRG system. Benchmarking involves comparing a hospital's costs and processes to peers in order to identify areas for improvement. The document outlines how benchmarking has been implemented in the Netherlands through connecting various data sources, developing a cost model, and using benchmarks in management. It emphasizes that benchmarking requires technology, but also top management commitment to discussions with doctors and using benchmarks in budgeting. The document concludes that while technology is important, benchmarking can be achieved today in Ireland through getting financial control and performing better despite budget constraints.
Delivered by Dr Michael Barry, National Centre for Pharmacoeconomics at the IPHA Annual Meeting 2010 during the Session entitled "Ensuring the best health outcomes for Irish patients while securing value for money".
Module 1 - Introduction to Energy EfficiencyPaul Brown
This document provides an introduction to energy efficiency, including:
- Defining energy efficiency as delivering the same or greater levels of energy services with less energy supply.
- Discussing the importance of energy efficiency for businesses in managing rising costs from carbon pricing policies and legislation, as well as maintaining their license to operate.
- Outlining the role of accountants and managers in supporting organizations to adopt more sustainable practices and implement energy efficiency projects through skills like communication, problem solving, and change management.
- Introducing change management as a process for shifting organizations to a desired future state through steps like assessing impact, planning changes, executing changes, and communications.
Hen 368 lecture 5 cost and benefit evaluation methodsGale Pooley
This document discusses various methods for evaluating the costs and benefits of health interventions, including cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), and cost-utility analysis (CUA). CBA measures costs and benefits in monetary terms. CEA compares costs and outcomes such as life years saved. CUA uses quality-adjusted life years (QALYs) to account for both quantity and quality of life by weighting life years by health utility scores. These methods help decision makers maximize health benefits given scarce resources.
The future of market access – the national picturePM Society
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Cost-benefit analysis (CBA) is a technique used to evaluate the costs and benefits of projects or interventions. It involves identifying and assigning monetary values to all relevant costs and benefits, including both direct and indirect effects. These costs and benefits are then discounted to present values and compared to determine if the net benefit is positive. If multiple alternatives exist, CBA can be used to select the alternative with the highest net benefit. Sensitivity analysis is also conducted to account for uncertainty in the estimates.
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NICE currently provides national guidance on health promotion and disease prevention and treatment. It issues guidance in public health, health technologies, and clinical practice based on comprehensive evidence reviews and expert input. NICE will take on responsibility for social care guidance in 2012. Quality standards are being developed to define high quality care and will include 150 topics over 5 years. NICE's guidance and quality standards will play a key role in the new NHS Outcomes Framework and in determining provider payment mechanisms. This expanded role may impact national and local priority setting.
Current guidelines do not recommend routine use of pCLE for pancreaticobiliary strictures. Further research is needed to define patient populations who would benefit, establish diagnostic criteria, assess clinical impact, and develop education programs to ensure proper training and competency. An ideal consensus would outline clear indications, standardized criteria, and requirements for physicians to achieve competency in pCLE interpretation.
This document discusses strategies for transitioning communities to more sustainable energy systems. It begins by showing projections for increasing global temperatures if carbon dioxide levels continue rising. It then outlines some options for decarbonizing energy systems by 2030 compared to business as usual scenarios. The rest of the document discusses various policies, programs, technologies and strategies that can be implemented to promote energy efficiency and sustainable energy, including setting targets, improving building standards, developing new business models, addressing customer perceptions, and promoting technology learning and integration. The overall message is that transitioning to sustainable energy will require a combination of effective policies, efficient programs, and engaging all stakeholders.
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This session is devoted to the design of feed-in tariff schemes for the large-scale dissemination of on-grid renewable energy technologies in developing countries. More than 50 countries have adopted a feed-in tariff both in developed and developing countries.
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After a brief introduction on the motivations to introduce renewable energy policies in developing countries, the session 3 examines the way to design and implement effective feed-in tariff: how to determine the eligible producer and technologies, how to calculated support levels, how to differentiate tariff payment, when to revise tariffs and plan tariff degression, etc.
This document describes the percentage of completion (POC) methodology for revenue recognition on engineering, procurement, and construction (EPC) projects. It explains that revenue is recognized based on either incurred costs or physical progress. The POC methodology incentivizes on-budget and cost management practices, results in more predictable profit margins, and allows profits to be recognized in a manner that better matches fiscal years. Key concepts discussed include underbilling/overbilling, treatment of client acquisitions and subcontractor billing.
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The document discusses key challenges and opportunities for market access in the NHS, including its complex structure with multiple decision makers, the role of appraisal bodies like NICE, reforms through the Health and Social Care Bill, and initiatives to promote innovation. It outlines the NHS's multi-layered structure with hospitals, GP surgeries, commissioning bodies and more. Technology must demonstrate benefits to patients, providers and the overall healthcare system to gain adoption in this environment.
This document proposes introducing the iSTAT point-of-care testing system at Vale of Leven Hospital to perform electrolyte and renal function tests out of hours, in order to save money and comply with working hours regulations. It outlines the current point-of-care options available, identifies the gap in not having electrolyte testing, and compares three options - maintaining the current out-of-hours laboratory system, using the iSTAT system, or awaiting new tests for the existing Gem analyzer. Costs and benefits of the iSTAT system are presented, showing an estimated first year net savings of £27,694 compared to current costs. Risks around staff satisfaction and increased demand are also discussed.
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Steps to Employment 2011 14 - staff trainingiteclearners
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This document provides an introduction to health technology assessment, which structures decision making about recommended medical treatments. It discusses how health technology assessment in Ireland uses quality-adjusted life years (QALYs) and cost-effectiveness to evaluate treatments. The QALY framework trades off treatment side effects, disability, and inconvenience against outcomes. Cost-effectiveness is communicated through the cost-effectiveness plane, which plots health gains against costs. A threshold of €45,000 per QALY is used to initially assess treatments, but other factors can also influence reimbursement decisions through an informal multi-criteria decision analysis approach.
This document summarizes a presentation given at the Primary Care Conference on livinghealth on November 17th, 2011 by Dr. David Molony. The presentation discussed innovation, research, and standards in primary care as well as barriers to development. Specific examples were given of an innovative warfarin clinic, a research study on ear health in the elderly, and developing standards for primary healthcare centers. Barriers to primary care development mentioned included a lack of flexibility and proper commitment of resources from hospitals. The presentation argued that primary care can provide many services more efficiently than hospitals and help address issues of cost and wait times if given more support and flexibility.
Energy Efficiency Innovation Driver or heavy Burden?Mateus Siwek
The Study provides information on
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› tasks and assistance for an energy manager
› Strategic implementation of energy efficiency measures and generation
of advantages for the site
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› Economic and legal Framework conditions
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Chapter 15 Quality Costs and Productivity : Measurement, Reporting, and Control Yesica Adicondro
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Transitional Care for Pediatric Patients with Neuromuscular Diseases: A Healt...HTAi Bilbao 2012
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Conditional Coverage. Access with evidence development. Claire McKenna.
1. Unifying research and coverage decisions:
How the assessment required can be informed
Claire McKenna
K Claxton, S Palmer, L Longworth†, L Bojke, S Griffin,
M Soares, E Spackman, J Youn†
Centre for Health Economics, University of York, UK
†Health Economics Research Group, Brunel University, UK
9th HTAi Annual Meeting Bilbao June 23-27, 2012
2. Allocation and research decisions
A number of conceptually distinct but simultaneous decisions must be made:
Which technology should be adopted into clinical practice given the existing
evidence base and the uncertainty surrounding outcomes and resource use?
Is additional evidence required to support the use of the technology?
- How uncertain are the expected benefits?
- Does this uncertainty matter (will it change the adoption decision)?
- How much does it matter (consequences of getting it wrong)?
What type of evidence would be most valuable?
Which research designs would be worthwhile?
When to approve the technology?
- Early approval? Can the evidence be provided with approval?
3. Policy options: Approve, Reject, OIR, AWR
Approve Could impact the prospects of acquiring further evidence
Reject Could restrict patient access to promising new technologies
Additional policies: overcomes the problems associated with making coverage decisions
under uncertainty
Only in research ‘No’ decision until further evidence establishes value
(OIR) - Only approved for use within the context of suitable
research study
Approve with research ‘Yes’ decision until further research is completed
(AWR) and guidance is established
4. What assessments are needed?
Expected cost-effectiveness
Irrecoverable costs
– Costs committed by approval that cannot be recovered
• Capital costs of long lived equipment (training and learning)
• Initial losses (negative NHE) offset by later gains
• Significance depends on whether initiation of treatment can be delayed
Value of additional evidence
The need for evidence, type of evidence, design of research
Uncertainty that cannot be resolved by research but only over time
Are the benefits of early approval greater than the opportunity costs?
Establish the circumstances when an OIR or AWR scheme may be an
appropriate policy option
5. Checklist of assessment
The sequence of assessment can be summarised as a simple 7-point checklist
†For technologies not expected to be cost-effective, point 4 becomes ‘Is the research possible without approval?’
7. Case study: EECP for chronic stable angina
Enhanced external counterpulsation (EECP) is a non-invasive procedure used
to treat chronic stable angina
Primary outcome is the symptomatic relief of angina symptoms
EECP has large initial upfront costs of treatment (£4,347 per patient), which are
irrecoverable once treated Long inflatable pressure cuffs are
inflated and deflated to increase
EECP as adjunct to standard therapy vs. blood flow to the coronary arteries
standard therapy alone
One RCT showed evidence of improved HRQoL
at 12 months
Uncertain whether HRQoL benefits are
sustained beyond 12 months
8. Point 1 - Is the technology expected to be cost-effective?
Assessment of effectiveness, potential for harm and costs over a patient time horizon
Assessment and judgement at points 1 and 2 of the checklist:
- Does not lead directly to guidance
- Determines subsequent pathway
Incremental mean costs £4,744
Incremental mean QALYs 0.2446 Treatment decision:
maximum expected net health effects
ICER for EECP £19,392
Cost-effectiveness at threshold (per QALY gained):
£10,000 £20,000 £30,000
Net health effects (NHEs):
EECP £70,071 £144,887 £219,702
Standard therapy £72,369 £144,738 £217,107
9. Point 2 – Are there significant irrecoverable costs?
5,000
Cumulative incremental NHE of EECP over the patient time horizon
Cumulative incremental NHE at population
0
0 5 10 15 20 25 30 35 40 45 50
level for EECP, QALY
-5,000
-10,000
-15,000
-20,000
Technology time horizon
-25,000
Time, years
10. Point 2 – Are there significant irrecoverable costs?
5,000
Cumulative incremental NHE of EECP over the patient time horizon
Cumulative incremental NHE at population
0
0 5 10 15 20 25 30 35 40 45 50
level for EECP, QALY
-5,000
Capital cost spread over 10 years
Capital cost incurred in year 1
-10,000
-15,000
-20,000
Technology time horizon
-25,000
Time, years
11. Point 3 – Does more research seem worthwhile?
i. How uncertain is a decision to approve or reject
ii. Do the likely consequences of uncertainty justify further research
• NHE that could be gained if it could be resolved immediately
• Upper bound on potential benefits of more research
• ‘No’ can lead directly to guidance
Cost-effectiveness threshold at £20,000 per QALY
Incremental NHE Probability Expected
Treatment QALY (£m) cost-effective consequences,
QALY (£m)
EECP 1,405 (28.1) 0.428
9,287
(185.7)
Standard care - 0.572
12. Point 3 – Does more research seem worthwhile?
0.45
Probability of no losses = 0.43
0.40
0.35
0.30
Probability
0.25 Expectation across the distribution of consequences
= 9,287 QALYs (£180m)
0.20
EVPI = Maximum value of research = £180m
0.15
0.10
0.05
0.00
0 [0,5000] [5000,10000] [10000, 15000] [15000,20000] [20000,25000] [25000,30000] [30000,35000] [35000,40000] [40000,45000]
Consequences, QALY
13. Point 4 - Is research possible with approval?
i. Type of evidence needed?
ii. Can the research be conducted while approved?
• Importance of parameters (values that change the decision)
• Uncertainty in possible values (how likely to change)
• NHE that are to be gained (expected consequences)
• Assessment and judgement at point 4
- Does not lead directly to guidance
- Determines whether AWR or OIR are possibilities
Expected consequences (QALYs)
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000
(1) Incremental HRQoL benefits in first year 8,127
(2) Probability of sustaining HRQoL benefits in
subsequent years (group of elicited parameters)
3,860
(3) 2-year probability of repeat EECP sessions 0
Overall decision uncertainty (EVPI) 9,287
14. Point 5 – Will other sources of uncertainty resolve over time?
i. Other sources of uncertainty
• Changes in price (technology and comparators)
• New technologies entering
• Other evidence becoming available
Types and categories of guidance for EECP that could ultimately result from
assessments up to point 6
Assessment 1 2 3 4 5 6 7 Guidance
17 Yes Yes Yes Yes No Yes Yes AWR 4
18 Yes Yes Yes Yes No Yes No OIR 4
19 Yes Yes Yes Yes No No - Approve 6
24 Yes Yes Yes No No Yes Yes Approve 9
25 Yes Yes Yes No No Yes No OIR 6
26 Yes Yes Yes No No No - Approve 10
15. Point 6 – Are the benefits of research greater than the costs?
i. Will the research be conducted? iii. How much uncertainty will be resolved?
ii. When will it be available? iv. Impact of other sources (point 5)
Expected consequences, £
£0 £40,000,000 £80,000,000 £120,000,000 £160,000,000 £200,000,000
0.00
Costs of research,
0.10 £1.5m (75 QALYs)
0.20
Probability of research
0.30
0.40
0.50
0.60
0.70
0.80
0.90 Research reports
9 8 7 6 5 4 3 2 1 year delay immediately
1.00
0 2,000 4,000 6,000 8,000 10,000
Expected consequences, QALY
16. Point 7 – Are the benefits of approval greater than the costs?
The final point on the checklist requires a comparison of the benefits of
approval and early access and the opportunity costs of approval
• Value of research forgone as a consequence
• Irrecoverable costs committed by approval
- Capital costs (equipment, facilities, training and learning)
- Initially negative NHE (when treatment decisions can be changed)
Types and categories of guidance for EECP that could ultimately result:
Assessment 1 2 3 4 5 6 7 Guidance
17 Yes Yes Yes Yes No Yes Yes AWR 4
18 Yes Yes Yes Yes No Yes No OIR 4
24 Yes Yes Yes No No Yes Yes Approve 9
25 Yes Yes Yes No No Yes No OIR 6
17. Point 7 – Are the benefits of approval greater than the costs?
The final point on the checklist requires a comparison of the benefits of
approval and early access and the opportunity costs of approval
• Value of research forgone as a consequence
• Irrecoverable costs committed by approval
- Capital costs (equipment, facilities, training and learning)
- Initially negative NHE (when treatment decisions can be changed)
Types and categories of guidance for EECP that could ultimately result:
Assessment 1 2 3 4 5 6 7 Guidance
17 Yes Yes Yes Yes No Yes Yes AWR 4
18 Yes Yes Yes Yes No Yes No OIR 4
24 Yes Yes Yes No No Yes Yes Approve 9
25 Yes Yes Yes No No Yes No OIR 6
Is research possible
with approval?
18. Point 7 – Are the benefits of approval greater than the costs?
The final point on the checklist requires a comparison of the benefits of
approval and early access and the opportunity costs of approval
• Value of research forgone as a consequence
• Irrecoverable costs committed by approval
- Capital costs (equipment, facilities, training and learning)
- Initially negative NHE (when treatment decisions can be changed)
Types and categories of guidance for EECP that could ultimately result:
Assessment 1 2 3 4 5 6 7 Guidance
17 Yes Yes Yes Yes No Yes Yes AWR 4
18 Yes Yes Yes Yes No Yes No OIR 4
24 Yes Yes Yes No No Yes Yes Approve 9
25 Yes Yes Yes No No Yes No OIR 6
Is research possible
with approval?
19. Technologies with significant irrecoverable costs
- Research is not possible with approval
0.0
An OIR or Approve boundary (EECP)
Probability that research is conducted
Sufficient condition for Approve
0.2
0.4
Necessary condition for OIR
0.6
4-year design
0.8 3-year design
2-year design
1-year design
1.0
0 1 2 3 4 5 6 7 8 9
Time for research to report, years
20. Evaluation of alternative research designs
- Research is possible with approval
OIR k = £20,000 AWR
£100,000 £40,000
Population ENBS x £1,000
Population ENBS x £1,000
£90,000 n* = 1,540 n* = 1,540
£35,000
£80,000 n* = 1,000
£30,000 n* = 900
£70,000
n* = 920 n* = 580
£60,000 £25,000
£50,000 n* = 720 £20,000 n* = 520
£40,000 4-year follow-up
£15,000 4-year follow-up
£30,000 3-year follow-up
£10,000 3-year follow-up
£20,000 2-year follow-up
2-year follow-up
£10,000 1-year follow-up £5,000
1-year follow-up
£0 £0
0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400 0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400
Sample size (n) Sample size (n)
21. Conclusions
Policy analysis based on value of information analysis can be used to
consider the value of:
i. being able to conduct research while a technology is approved;
ii. the trade-off between the expected NHEs to current patients from
early access and the NHEs to future patients from more research;
Understanding the relationship between the time taken for research to report
and the value of the evidence can help inform:
i. investments which might make research findings available quickly
ii. the trade-off implicit in the choice of alternative research designs
iii. those areas where research must be reported quickly to be of value
Claxton et al. (2012) Uncertainty, Evidence and Irrecoverable Costs: Informing Approval,
Pricing and Research Decisions for Health Technologies. CHE Research Paper 69.
http://www.york.ac.uk/che/publications/in-house/