Resource allocation and economic evaluation in Australia's healthcare system

2011 ◽  
Vol 35 (3) ◽  
pp. 278 ◽  
Author(s):  
Abdolvahab Baghbanian ◽  
Ian Hughes ◽  
Freidoon A. Khavarpour
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Healthcare Decision ◽  
Effectiveness Analysis ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective. To explore dimensions and varieties of economic evaluations that healthcare decision-makers do or do not use. Design. Web-based survey. Setting and participants. A purposive sample of Australian healthcare decision-makers was recruited by direct invitation through email. All were invited to complete an online questionnaire derived from the EUROMET 2004 survey. Results. A total of 91 questionnaires were analysed. Almost all participants were involved in financial resource allocations. Most commonly, participants based their decisions on patient needs, effectiveness of interventions, cost of interventions or overall budgetary effect, and policy directives. Evidence from cost-effectiveness analysis was used by half of the participants. Timing, ethical issues and lack of knowledge about economic evaluation were the most significant barriers to the use of economic evaluations in resource allocation decisions. Most participants reported being moderately to very familiar with the cost-effectiveness analysis. There was a general impression that evidence from economic evaluations should play a larger role in the future. Conclusions. Evidence from health economic evaluations may provide valuable information in some decisions; however, at present, it is not central to many decisions. The study suggests that, for economic evaluation to be helpful in real-life policy decisions, it has to be placed into context – a context which is complex, political and often resistant to voluntary change. What is known about the topic? There are increasing calls for the use of evidence from formal economic evaluations to improve the quality of healthcare decision making; however, it is widely acknowledged that such evidence, as presently constituted, is underused in its influence on allocation decisions. What does this paper add? This study highlights that resource allocation decisions cannot be purely based on the use of technical, economic data or systematic evidence-based reviews. In order to exploit the full potential value of economic evaluations, researchers need to make better sense of decision contexts at specific times and places. What are the implications for practitioners? The study has the potential to expand researchers and policy-makers’ understanding of the limited use of economic evaluation in decision-making. It produces evidence that decision-making in Australia’s healthcare system is not or cannot be a fully rational bounded process. Economic evaluation is used in some contexts, where information is accurate, complete and available.

Adaptive decision-making: how Australian healthcare managers decide

2012 ◽  
Vol 36 (1) ◽  
pp. 49 ◽  
Author(s):  
Abdolvahab Baghbanian ◽  
Ian Hughes ◽  
Ali Kebriaei ◽  
Freidoon A. Khavarpour
Keyword(s):  
Decision Making ◽  
Resource Allocation ◽  
Health Policy ◽  
Research Evidence ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Evidence Based ◽  
Full Potential ◽  
Healthcare Decision ◽  
Adaptive Decision Making

Despite many calls for the utilisation of research evidence in health policy-making, it is not widely practised, and little is known about how decision-makers in healthcare organisations actually make decisions. We recruited a purposive sample of Australian healthcare decision-makers to complete a web-based survey. We then took a sub-sample from willing respondents for individual interviews. All interviews were audio-recorded, transcribed verbatim and coded thematically. We found that resource allocation decision-making varied greatly across the Australian healthcare system. Decision-making was highly dependent on the operational context in time, place and purpose, and that research evidence was rarely exploited to its full potential. Decision-making involved a multifaceted interplay of elements in situation of inquiry. All decisions were made by networks or collectives of people; and no instance of individual decision-making was reported. This varied, social and contextual nature of decision-making points to a complexity that is not reflected in systematic evidence-based reviews or evidence-based models for decision-making, and we did not discover an appropriate model to reflect this complexity in the health- related literature. We developed a model of ‘adaptive decision-making’ that has potential to guide robust decision-making in complex situations, and could have some value as an explanatory or theoretical model for teaching and practice. What is known about the topic? The topic is certainly novel and original, relevant and timely for academics and healthcare decision-makers. Despite increasing calls for the use of systematic evidence-based reviews including economic evaluations, the way in which decision-makers arrive at their allocation decisions and how such decisions reflect concern for economic efficiency is often blurred. This topic is an important one for its relevance to the current difficulties in the complex situation of healthcare. What does this paper add? This paper shows that decision-makers acknowledged the integration of economic principles as contextual realities into their decision-making activities, rather than utilising the results of ever-more seemingly ‘technically sound’ economic evaluations, which cannot address the inherent uncertainty attached to complex decision-making activities. We developed a novel adaptive model of decision-making generated by the interplay of multiple behaviours and factors in the situation of inquiry. The model is new and takes into account the complexity of the context in time, place, purpose and administrative location. What are the implications for practitioners? This paper should be of interest to a broad readership including those interested in health economics, public health policy, healthcare delivery, healthcare resource allocation and decision-making. The adaptive decision-making model designed in this study has the potential as a guide or heuristic device for teaching and practice. Healthcare decision-makers need to be prepared for complexity and ambiguity and cannot expect the data to tell them everything they need to know. We expect to see a shift in the literature on healthcare decision-making, not away from evidence-based practice and economic evaluation, but towards contextualising these methods in broader, adaptive models of decision-making.

scholarly journals Application of A Framework to Guide Policy on Healthcare Resource Allocation Decisions to Data Linkage Projects

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Ian Olver
Keyword(s):  
Resource Allocation ◽  
Data Linkage ◽  
Health Data ◽  
Decision Makers ◽  
Data Sets ◽  
Policy Decisions ◽  
The Public ◽  
Health Resource Allocation ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

IntroductionData linkage of population data sets often across jurisdictions or linking health data sets or health data with non-health data often involves balancing ethical principles such as privacy with beneficence as represented by the public good. Similar ethical dilemmas occur in health resource allocation decisions. The NHMRC have published a framework to guide policy on health resource allocation decisions that could be applied to ensure the justification of data linkage projects that is defensible as in the interest of the public good. Objectives and ApproachThe four main conditions for legitimacy of policy decisions about access to healthcare in a democracy with a public health system and limited resources wereexamined for their relevance to decisions about the use of public data and linking data sets. ResultsPublic policy decisions must be defensible and responsive to the interests of those affected. Decision-makers should articulate their reasoning and recommendations so that citizens can judge them. While the context of policy decisions will differ, their legitimacy depends upon (1) the transparency of the reasoning which should be free from conflicts of interest, the basis for decisions recorded and report widely, (2) the accountability of the decision-makers to the wider community, (3) the testability of the evidence used to inform the decision-making, which usually means that it will stand up to independent review and(4) the inclusive recognition of those the decision affects which often requires that the implications for disadvantaged groups are considered, even if they can’t always be accommodated. These conditions are interrelated but ensure that the good of society in general and not just specific dominant groups are accommodated. Conclusion / ImplicationsIt these principles are applied to decisions about data linkage projects they have clear applicability in society accepting data linkage projects having balanced the good against the ethical risks involved.

scholarly journals Taking stock of cost-effectiveness analysis of healthcare in China

2019 ◽  
Vol 4 (3) ◽  
pp. e001418 ◽  
Author(s):  
Thomas Butt ◽  
Gordon G Liu ◽  
David D Kim ◽  
Peter J Neumann
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
English Language ◽  
Mainland China ◽  
Cost Effectiveness Analysis ◽  
Healthcare Decision ◽  
Reporting Practices ◽  
The Past ◽  
Effectiveness Analysis ◽  
Healthcare Decision Making

IntroductionCost-effectiveness analysis (CEA) is playing an increasingly important role in informing healthcare decision-making in China. This study aims to review the published literature on CEA in mainland China and describe its characteristics and evolution. We provide recommendations on the future direction of CEA as a methodology and as a tool to support healthcare decision-making in China.MethodsEnglish-language cost-per-quality-adjusted life-year (QALY) and cost-per-disability-adjusted life-year (DALY) publications relating to mainland China were reviewed using the Tufts Medical Center Cost-Effectiveness Analysis Registry and Global Health Cost-Effectiveness Analysis Registry through 2017. Study features were summarised using descriptive statistics. Changes in study methodology over time were analysed by trend test, and study characteristics influencing the incremental cost-effectiveness ratio (ICER) of cost-per-QALY studies were investigated using logistic regression.Results170 studies were identified reporting CEA for mainland China (cost/QALY=125, cost/DALY=45) since 1998. The number and quality of studies has increased over the past two decades, with significantly more cost-per-QALY studies compared with cost-per-DALY studies (p<0.0001) and more studies with authors affiliated with Chinese institutions (p=0.0002). The average quality score was 5.04 out of 7 for cost-per-QALY and 4.70 for cost-per-DALY studies based on Registry reviewers’ subjective assessment of overall quality (methods, assumptions and reporting practices). The median ICER reported for interventions for oncology patients was higher (US$26 694 per QALY) than the median ICER reported for all interventions (US$11 503 per QALY). Oncology interventions were associated with the likelihood of reporting higher ICERs than the median ICER (p=0.003).ConclusionThe number of English-language published CEA studies relating to China has grown rapidly over the past 20 years. In terms of quality, the China studies compare favourably with international studies, although they remain a small proportion of studies globally.

scholarly journals Economic evaluation of meningococcal vaccines: considerations for the future

2019 ◽  
Vol 21 (2) ◽  
pp. 297-309 ◽  
Author(s):  
Hannah Christensen ◽  
Hareth Al-Janabi ◽  
Pierre Levy ◽  
Maarten J. Postma ◽  
David E. Bloom ◽  
...  
Keyword(s):  
Decision Making ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Meningococcal Disease ◽  
Indirect Costs ◽  
Evaluation Methods ◽  
Economic Evaluations ◽  
Meningococcal Vaccines ◽  
Vaccine Introduction ◽  
Life Years

AbstractIn 2018, a panel of health economics and meningococcal disease experts convened to review methodologies, frameworks, and decision-making processes for economic evaluations of vaccines, with a focus on evaluation of vaccines targeting invasive meningococcal disease (IMD). The panel discussed vaccine evaluation methods across countries; IMD prevention benefits that are well quantified using current methods, not well quantified, or missing in current cost-effectiveness methodologies; and development of recommendations for future evaluation methods. Consensus was reached on a number of points and further consideration was deemed necessary for some topics. Experts agreed that the unpredictability of IMD complicates an accurate evaluation of meningococcal vaccine benefits and that vaccine cost-effectiveness evaluations should encompass indirect benefits, both for meningococcal vaccines and vaccines in general. In addition, the panel agreed that transparency in the vaccine decision-making process is beneficial and should be implemented when possible. Further discussion is required to ascertain: how enhancing consistency of frameworks for evaluating outcomes of vaccine introduction can be improved; reviews of existing tools used to capture quality of life; how indirect costs are considered within models; and whether and how the weighting of quality-adjusted life-years (QALY), application of QALY adjustment factors, or use of altered cost-effectiveness thresholds should be used in the economic evaluation of vaccines.

CASE STUDIES THAT ILLUSTRATE DISINVESTMENT AND RESOURCE ALLOCATION DECISION-MAKING PROCESSES IN HEALTH CARE: A SYSTEMATIC REVIEW

2013 ◽  
Vol 29 (2) ◽  
pp. 174-184 ◽  
Author(s):  
Julie Polisena ◽  
Tammy Clifford ◽  
Adam G. Elshaug ◽  
Craig Mitton ◽  
Erin Russell ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Resource Allocation ◽  
Case Studies ◽  
Resource Allocation Decision ◽  
Cochrane Library ◽  
Fee For Service ◽  
Allocation Decision ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Objective:Technological change accounts for approximately 25 percent of health expenditure growth. To date, limited research has been published on case studies of disinvestment and resource allocation decision making in clinical practice. Our research objective is to systematically review and catalogue the application of frameworks and tools for disinvestment and resource allocation decision making in health care.Methods:An electronic literature search was executed for studies on disinvestment, obsolete and ineffective technologies, and priority healthcare setting, published from January 1990 until January 2012. Databases searched were MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, Embase, The Cochrane Library, PubMed, and HEED.Results:Fourteen case studies on the application of frameworks and tools for disinvestment and resource allocation decisions were included. Most studies described the application of program budgeting and marginal analysis (PBMA), and two reports used health technology assessment (HTA) methods for coverage decisions in a national fee-for-service structure. Numerous healthcare technologies and services were covered across the studies. We describe the multiple criteria considered for decision making, and the strengths and limitations of these frameworks and tools are highlighted.Conclusions:Disinvestment and resource allocation decisions require evidence to ensure their transparency and objectivity. PBMA was used to assess resource allocation of health services and technologies in a fixed budget jurisdiction, while HTA reviews focused on specific technologies, principally in fee-for-service structures. Future research can review the data requirements and explore opportunities to increase the quantity of available evidence for disinvestment and resource allocation decisions.

Cost-Effectiveness and Educational Policy

1988 ◽  
Vol 10 (1) ◽  
pp. 51-69 ◽  
Author(s):  
Henry M. Levin
Keyword(s):  
Resource Allocation ◽  
Cost Effectiveness ◽  
Educational Policy ◽  
Educational Reform ◽  
Cost Effectiveness Analysis ◽  
Decision Makers ◽  
Effectiveness Analysis ◽  
Efficient Resource ◽  
Policy Analysts

The present time of educational reform and budgetary stringency is a propitious one for improving resource allocation in education through a greater reliance on cost-effectiveness analysis. This article provides a summary of the technique and its applications to educational policy. It concludes that there is great potential for the use of cost-effectiveness applications in education, but there is little capability for doing so among most policymakers. Examples are provided of productive cost-effectiveness applications, and recommendations are made with regard to increasing the capacity of educational evaluators, policy analysts, and decision-makers to use the tools appropriately for more efficient resource allocation.

scholarly journals Understanding cost data collection tools to improve economic evaluations of health interventions

2019 ◽  
Vol 4 (4) ◽  
pp. 214-222 ◽  
Author(s):  
John M Chapel ◽  
Guijing Wang
Keyword(s):  
Resource Allocation ◽  
Data Collection ◽  
Health Interventions ◽  
Cost Data ◽  
Economic Evaluations ◽  
Cost Estimates ◽  
Practical Applications ◽  
Intervention Cost ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

Micro-costing data collection tools often used in literature include standardized comprehensive templates, targeted questionnaires, activity logs, on-site administrative databases, and direct observation. These tools are not mutually exclusive and are often used in combination. Each tool has unique merits and limitations, and some may be more applicable than others under different circumstances. Proper application of micro-costing tools can produce quality cost estimates and enhance the usefulness of economic evaluations to inform resource allocation decisions. A common method to derive both fixed and variable costs of an intervention involves collecting data from the bottom up for each resource consumed (micro-costing). We scanned economic evaluation literature published in 2008-2018 and identified micro-costing data collection tools used. We categorized the identified tools and discuss their practical applications in an example study of health interventions, including their potential strengths and weaknesses. Sound economic evaluations of health interventions provide valuable information for justifying resource allocation decisions, planning for implementation, and enhancing the sustainability of the interventions. However, the quality of intervention cost estimates is seldom addressed in the literature. Reliable cost data forms the foundation of economic evaluations, and without reliable estimates, evaluation results, such as cost-effectiveness measures, could be misleading. In this project, we identified data collection tools often used to obtain reliable data for estimating costs of interventions that prevent and manage chronic conditions and considered practical applications to promote their use.

scholarly journals A Qualitative Study of the Views of Health and Social Care Decision-makers on the Role of Wellbeing in Resource Allocation Decisions in the UK

Economies ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 14
Author(s):  
Tessa Peasgood ◽  
Jill Carlton ◽  
John Brazier
Keyword(s):  
Resource Allocation ◽  
Subjective Wellbeing ◽  
Social Care ◽  
Decision Makers ◽  
Structured Interviews ◽  
Health And Social Care ◽  
The Uk ◽  
Allocation Decisions ◽  
Resource Allocation Decisions

There has been growing international interest in the role that wellbeing measures could play within policy making in health and social care. This project explored the opinions of a sample of UK decision-makers on the relevance of wellbeing and subjective wellbeing (by which we mean good and bad feelings or overall evaluations of life, such as life satisfaction) for resource allocation decisions within health and social care. Through these discussions we draw out the perceived advantages and the potential concerns that decision-makers have about broadening out to wellbeing and subjective wellbeing rather than just measuring health. Three focus groups were conducted: with members of the National Institute for Health and Care Excellence (NICE) Citizen’s Council, with a Health and Wellbeing Board at a Local Authority and with Public Health England. In addition, eleven semi-structured interviews were held with staff from NHS England and members of a range of NICE committees. We identified a range of opinions about the role of wellbeing and a broadly held view that there was a need for improved consideration of broader quality of life outcomes. We also identified considerable caution in relation to the use of subjective wellbeing.

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