scholarly journals Conservation cost‐effectiveness: a review of the evidence base

2021 ◽  
Author(s):  
Thomas Pienkowski ◽  
Carly Cook ◽  
Megha Verma ◽  
Luis Roman Carrasco
Keyword(s):  
Cost Effectiveness ◽  
Evidence Base ◽  
Conservation Cost

The economic evaluation of complementary medicine: a staged approach at the Royal London Homoeopathic Hospital

2000 ◽  
Vol 89 (S 01) ◽  
pp. S23-S26 ◽  
Author(s):  
R van Haselen
Keyword(s):  
Rheumatoid Arthritis ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Complementary Medicine ◽  
Evidence Base ◽  
Practical Implementation ◽  
Health State ◽  
Marginal Costs ◽  
Related Quality ◽  
Staged Approach

AbstractObjective: The practical implementation of a staged, multifaceted research agenda for the economic evaluation of complementary medicine (CM) at the Royal London Homoeopathic Hospital (RLHH).Method: The relative importance of economic evaluation as an evidence base of CM was assessed via a survey conducted with purchasers (n=481). The marginal costs of providing complementary care for patients with rheumatoid arthritis were calculated. The use, and changes in the use, of conventional medicines for patients’ main complaints were established retrospectively (n=499) and prospectively (n=70). Health-related quality of life (patient utility) of newly referred patients was assessed with the EQ-5D (EuroQol) instrument (n=70) on a 100 mm (0=worst, 100=best) scale.Results: Economic evaluation was rated ‘important’ as an evidence base, after safety and RCT data (‘very important’). Consultation time (doctors and dietician) contributed 29% of the total costs of treating rheumatoid arthritis. The retrospective survey showed that many patients on conventional medication were able to stop (29%) or reduce (32%) intake in the course of treatment. The median (quartiles) health state of newly referred patients was 70 mm (50,78) in men and 60 mm (36,73) in women. Some results of an interim analysis of 6 months follow-up data are reported.Conclusions: Economic evaluation of CM is becoming increasingly important and should take place by using a multifaceted, staged approach. Before embarking on randomised trials, observational data on cost, effectiveness and utility should be collected. The cost-effectiveness of CM appears to be most sensitive to the duration of the consultation.

EVIDENCE, VALUES, AND DECISION MAKING

2014 ◽  
Vol 30 (2) ◽  
pp. 233-238 ◽  
Author(s):  
Michael D. Rawlins
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Observational Study ◽  
Social Values ◽  
Clinical Excellence ◽  
Health Technology ◽  
Evidence Base ◽  
Social Value ◽  
Value Judgments ◽  
Study Designs

Background: The evidence supporting the use of new, or established, interventions may be derived from either (or both) experimental or observational study designs. Although a rigorous examination of the evidence base for clinical and cost-effectiveness is essential, it is never sufficient, and those undertaking a health technology assessment (HTA) also have to exercise judgments.Methods: The basis for this discussion is largely from the author's experience as chairman of the national Institute for Health and Clinical Excellence (NICE).Results: The judgments necessary for HTA to make are twofold. Scientific judgments relate to the interpretation of the science. Social value judgments are concerned with the ethical principles, preferences, culture, and aspirations of society.Conclusions: How scientific and social value judgments might be most appropriately captured is a challenge for all HTA agencies. Although competent HTA bodies should be able to exercise scientific judgments they have no legitimacy to impose their own social values. These must ultimately be informed by the general public.

scholarly journals Challenges in synthesising cost-effectiveness estimates

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Gemma E. Shields ◽  
Jamie Elvidge
Keyword(s):  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Study Designs

AbstractEconomic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.

The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients

2004 ◽  
Vol 14 (5) ◽  
pp. 931-937 ◽  
Author(s):  
W. A. A. Tjalma ◽  
P. A. Van Dam ◽  
A. P. Makar ◽  
D. J. Cruickshank
Keyword(s):  
Endometrial Cancer ◽  
Cost Effectiveness ◽  
Cancer Patients ◽  
Survival Rates ◽  
Risk Groups ◽  
Evidence Base ◽  
Clinical Value ◽  
The Times ◽  
The Cost

The aim of the present article was to evaluate the cost-effectiveness of follow-up in endometrial cancer patients. A literature review was performed regarding the studies that addressed routine follow-up of endometrial cancer. For each published study, the costs of the follow-up program were calculated according to Belgium standards. A mean total of 13% relapsed. Symptomatology and clinical examination detected over 83% of the recurrences. The follow-up cost in euro after 5 and 10 years ranged between 127.68 and 2028.78 and between 207.48 and 2353.48, respectively. Based on the available data, there is little evidence of routine follow-up improving survival rates. Multiple protocols are used in practice without an evidence base. There is an urgent need for prospective randomized studies to evaluate the value of the current so-called ‘standard medical practice of follow-up.’ It is to be expected that the cost of follow-up could be reduced considerably, for instance, by tailoring to low- and high-risk groups, or by abandoning routine follow-up. Symptomatic patients, however, should be evaluated immediately. A reduction in the number of visits and examinations would mean an enormous reduction in costs. This economic benefit would be warmly welcomed in the times of increased health costs and decreased budgets.

scholarly journals APPROACHES TO EVALUATE TRANSPORT COSTING IN INDIA – AN EXPLORATORY STUDY

2021 ◽  
pp. 15-18
Author(s):  
Mahesha, V
Keyword(s):  
Cost Effectiveness ◽  
Exploratory Study ◽  
Travel Demand ◽  
Cost Effective ◽  
Research Paper ◽  
Evidence Base ◽  
Transport Sector ◽  
Cost Factor ◽  
Carbon Reduction ◽  
Different Types

This research paper has made an attempt to study the background and strength of cost factor in transport sector. The analysis can be condense into three crucial issues which,depending on how they are handled in any analysis,together dictate whether or not transport measures will be deemed a more or less cost-effective route to carbon reduction. In short,these are the postulation about future costs and level of travel demand,the methods applied to compare policies for cost-effectiveness and the evidence base used in relation to different types and combinations of policy instrument.So in view of this,the present study assumes a great importance to put the light on transport costing.

scholarly journals Concomitant health benefits package design and research prioritisation: development of a new approach and an application to Malawi

2021 ◽  
Vol 6 (12) ◽  
pp. e007047
Author(s):  
Laetitia Schmitt ◽  
Jessica Ochalek ◽  
Karl Claxton ◽  
Paul Revill ◽  
Dominic Nkhoma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Benefits ◽  
Health Sector ◽  
Research Priorities ◽  
Evidence Base ◽  
Preventive Therapy ◽  
Acute Malnutrition ◽  
Health Coverage ◽  
Life Years ◽  
Research Prioritisation

Health benefits packages (HBPs) are increasingly used in many countries to guide spending priorities on the path towards universal health coverage. Their design is, however, informed by an uncertain evidence base but research funds available to address this are limited. This gives rise to the question of which piece of research relating to the cost-effectiveness of interventions would most contribute to improving resource allocation. We propose to incorporate research prioritisation as an integral part of HBP design. We have, therefore, developed a framework and a freely available companion stand-alone tool, to quantify in terms of net disability-adjusted life-years (DALYs) averted, the value of research for the interventions considered for inclusion in a package. Using the tool, the framework can be implemented using sensitivity analysis results typically reported in cost-effectiveness studies. To illustrate the framework, we applied the tool to the evidence base that informed the Malawi Health Sector Strategic Plan 2017–2022. Out of 21 interventions considered, 8 investment decisions were found to be uncertain and three showed strong potential for research to generate large health gains: ‘male circumcision’, ‘community-management of acute malnutrition in children’ and ‘isoniazid preventive therapy in HIV +individuals’, with a potential to avert up to 65 762, 36 438 and 20 132 net DALYs, respectively. Our work can help set research priorities in resource-constrained settings so that research funds are invested where they have the largest potential to impact on the population health generated via HBPs.

scholarly journals Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

2017 ◽  
Vol 5 (14) ◽  
pp. 1-834 ◽  
Author(s):  
Denise Kendrick ◽  
Joanne Ablewhite ◽  
Felix Achana ◽  
Penny Benford ◽  
Rose Clacy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Usual Care ◽  
Injury Prevention ◽  
Fire Safety ◽  
Evidence Base ◽  
Home Safety ◽  
Case Control Studies ◽  
Safety Interventions ◽  
Meta Analyses ◽  
Children’S Centres

BackgroundUnintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.AimTo increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.MethodsSix work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.ResultsModifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.LimitationsOur case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.ConclusionsOur studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.Future workFurther randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.Trial registrationCurrent Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

A systematic review of the cost-effectiveness of interventions for supporting informal caregivers of people with dementia residing in the community

2011 ◽  
Vol 24 (1) ◽  
pp. 6-18 ◽  
Author(s):  
Carys Jones ◽  
Rhiannon Tudor Edwards ◽  
Barry Hounsome
Keyword(s):  
Cost Effectiveness ◽  
Informal Caregivers ◽  
Healthcare Services ◽  
Evidence Base ◽  
Economic Evaluations ◽  
People With Dementia ◽  
Significant Difference ◽  
Item Checklist ◽  
The Cost

ABSTRACTBackground: Dementia places a huge demand on healthcare services; however, a large proportion of the cost is borne by informal caregivers. With the number of people affected by dementia set to increase in the future, there is a need for research to consider the effects of interventions on informal caregivers as well as on the individuals with dementia. This paper seeks to systematically review the existing evidence on the cost-effectiveness of interventions to support informal caregivers of people with dementia residing in the community.Methods: A range of electronic databases was searched. Studies were included if both costs and outcome measures for informal caregivers of people with dementia residing in the community were reported for an intervention. Both pharmacological and non-pharmacological interventions were included. Quality of study was assessed using the Drummond ten-item checklist for economic evaluations and results were presented through narrative synthesis.Results: Twelve studies were included in the review; of these only four reported a significant difference in the outcome measure for caregivers.Conclusions: At present few published studies report costs in enough detail to provide evidence of the effectiveness and cost-effectiveness of interventions for supporting caregivers. Future trials need to collect caregiver data alongside patient data in order to increase the evidence base for intervention effectiveness. Further research is required to establish the effectiveness and cost-effectiveness of both pharmacological and non-pharmacological approaches.

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