scholarly journals Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users

2021 ◽  
Vol 25 (35) ◽  
pp. 1-234
Author(s):  
Martin O’Flaherty ◽  
Ffion Lloyd-Williams ◽  
Simon Capewell ◽  
Angela Boland ◽  
Michelle Maden ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Health Technology ◽  
Health Check ◽  
Local Authorities ◽  
User Friendly ◽  
Future Work ◽  
Nhs Health Check

Background Local authorities in England commission the NHS Health Check programme to invite everyone aged 40–74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme’s effectiveness, cost-effectiveness and equity impact remain uncertain. Aim To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. Objectives The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. Design Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. Setting Local authorities in England. Participants Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. Interventions The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. Main outcome measures Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. Results The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct ‘best buy’. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. Limitations Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. Conclusions Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. Future work Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. Study registration This study is registered as PROSPERO CRD42019132087. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.

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 Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

2019 ◽  
Vol 7 (26) ◽  
pp. 1-122 ◽  
Author(s):  
Joanne Turnbull ◽  
Gemma McKenna ◽  
Jane Prichard ◽  
Anne Rogers ◽  
Robert Crouch ◽  
...  
Keyword(s):  
Decision Making ◽  
Literature Review ◽  
Help Seeking ◽  
Service Use ◽  
Urgent Care ◽  
Sense Making ◽  
Service Users ◽  
The Public ◽  
Care Services ◽  
Future Work

BackgroundPolicy has been focused on reducing unnecessary emergency department attendances by providing more responsive urgent care services and guiding patients to ‘the right place’. The variety of services has created a complex urgent care landscape for people to access and navigate.ObjectivesTo describe how the public, providers and policy-makers define and make sense of urgent care; to explain how sense-making influences patients’ strategies and choices; to analyse patient ‘work’ in understanding, navigating and choosing urgent care; to explain urgent care utilisation; and to identify potentially modifiable factors in decision-making.DesignMixed-methods sequential design.SettingFour counties in southern England coterminous with a NHS 111 provider area.MethodsA literature review of policy and research combined with citizens’ panels and serial qualitative interviews. Four citizens’ panels were conducted with the public, health-care professionals, commissioners and managers (n = 41). Three populations were sampled for interview: people aged ≥ 75 years, people aged 18–26 years and East European people. In total, 134 interviews were conducted. Analyses were integrated to develop a conceptual model of urgent care help-seeking.FindingsThe literature review identified some consensus between policy and provider perspectives regarding the physiological factors that feature in conceptualisations of urgent care. However, the terms ‘urgent’ and ‘emergency’ lack specificity or consistency in meaning. Boundaries between urgent and emergency care are ill-defined. We constructed a typology that distinguishes three types of work that take place at both the individual and social network levels in relation to urgent care sense-making and help-seeking.Illness workinvolves interpretation and decision-making about the meaning, severity and management of physical symptoms and psychological states, and the assessment and management of possible risks. Help-seeking was guided bymoral work: the legitimation and sanctioning done by service users.Navigation workconcerned choosing and accessing services and relied on prior knowledge of what was available, accessible and acceptable. From these empirical data, we developed a model of urgent care sense-making and help-seeking behaviour that emphasises that work informs the interaction between what we think and feel about illness and the need to seek care (sense-making) and action – the decisions we take and how we use urgent care (help-seeking).LimitationsThe sample population of our three groups may not have adequately reflected a diverse range of views and experiences. The study enabled us to capture people’s views and self-reported service use rather than their actual behaviour.ConclusionsMuch of the policy surrounding urgent and emergency care is predicated on the notion that ‘urgent’ sits neatly between emergency and routine; however, service users in particular struggle to distinguish urgent from emergency or routine care. Rather than focusing on individual sense-making, future work should attend to social and temporal contexts that have an impact on help-seeking (e.g. why people find it more difficult to manage pain at night), and how different social networks shape service use.Future workA whole-systems approach considering integration across a wider network of partners is key to understanding the complex relationships between demand for and access to urgent care.Study registrationThis study is registered as UKCRN 32207.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Imaginary Worlds: The European Network for Health Technology Assessment (EUnetHTA) Recommendations for Health Economic Evaluations

2016 ◽  
Vol 7 (3) ◽  
Author(s):  
Paul C Langley
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Relative Effectiveness ◽  
Health Technology ◽  
Economic Evaluations ◽  
Normal Science ◽  
European Network ◽  
Health Technologies

The European Network for Health Technology Assessment (EUnetHTA) guidelines for health economic evaluations represent a consolidated view of non-binding recommendations for assessments of the relative effectiveness of pharmaceuticals or other health technologies. EUnetHTA views itself as the scientific and technological backbone of the development of health technology assessment in the European Union and among its member states and other partners. Unfortunately, the standards for health technology assessment proposed by EUnetHTA do not meet the standards of normal science. They do not support credible claims for the clinical and comparative cost-effectiveness of pharmaceuticals. In rejecting the standards of normal science the guidelines put to one side the opportunity not only to re-assess and replicate clinical and cost-effectiveness claims but to provide meaningful feedback on claims assessment to health care decision makers. The purpose of this review is to make the case that, in failing to support standards for experimentation, EUnetHTA is advocating its partners support the creation of modeled or simulated imaginary or false worlds. While EUnetHTA is not alone in recommending the construction of imaginary worlds to support formulary decisions, there is still the opportunity to revisit these recommendations and decide whether or not to encourage a scientifically rigorous approach to health technology assessments - to abandon a commitment to intelligent design in favor of natural selection.  Conflict of Interest None   Type: Commentary  

Health economic impact of breast cancer index (BCI) in patients with hormone responsive breast cancer (HRBC) considering extended adjuvant endocrine therapy (EET).

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 25-25
Author(s):  
Tara Beth Sanft ◽  
Alyssa Berkowitz ◽  
Brock Schroeder ◽  
Christos Hatzis ◽  
Catherine A. Schnabel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Endocrine Therapy ◽  
Cost Savings ◽  
Adjuvant Endocrine Therapy ◽  
Sensitivity Analyses ◽  
Breast Cancer Index ◽  
The Cost

25 Background: Previous research has demonstrated the benefit of EET for HRBC, however, the absolute benefit is modest and commits women to an extra 5 yrs of treatment. The Breast Cancer Index (BCI) is a gene expression-based test that has been validated to quantify the risk of late recurrence (BCI subscore) and to predict likelihood of benefit from EET (H/I subscore). We have previously shown that the use of BCI increases patient and physician confidence in decision-making and leads to fewer recommendations for EET. The current analysis extends our results to a larger sample size and presents a health economic analysis to assess the cost effectiveness of the use of BCI for EET decision-making. Methods: We developed a fact-based economic model to project the cost effectiveness of BCI using a cohort of 140 patients with stage I-III HRBC from Yale Cancer Center and University of Pittsburgh Medical Center who had completed ≥3.5 yrs of endocrine therapy and had undergone BCI testing in the context of this study. Physicians completed questionnaires to indicate their recommendations for EET before and after BCI results. Costs associated with EET, toxicity, follow-up, and metastatic recurrence were modeled over 5 yrs of extended therapy. Model inputs were based on published literature. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Changes in EET recommendations after BCI were observed in 29% of patients, with 21% changing from recommended to not recommended, and 8% from not recommended to recommended. The projected net cost savings of BCI testing in this population of patients who are disease free at 5 yrs post-diagnosis is $5,190 per patient tested. Gross cost savings were projected to be achieved through reduced recurrence in patients receiving EET based on BCI results and decreased adverse events and comorbidities for patients with low BCI scores who did not receive EET. Conclusions: Based on the decision impact of BCI in a real-world cohort, the test is projected to be cost saving for women with early stage hormone receptor positive breast cancer who are recurrence free at 5 yrs post-diagnosis on adjuvant endocrine therapy.

The cost-effectiveness of metformin in pre-diabetics: a systematic literature review of health economic evaluations

2019 ◽  
Vol 20 (2) ◽  
pp. 207-219
Author(s):  
Samron Brhane Gebregergish ◽  
Mahmoud Hashim ◽  
Bart Heeg ◽  
Thomas Wilke ◽  
Marco Rauland ◽  
...  
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Economic Evaluations ◽  
The Cost

PP70 Health Technology Assessment Evaluations Of Combination Drugs: The Italian Case Study

2018 ◽  
Vol 34 (S1) ◽  
pp. 95-95
Author(s):  
Dilani Angela Solaman ◽  
Claudio Jommi ◽  
Andrew Walker ◽  
Hanim Edoo ◽  
Mark Ratcliffe
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Multiple Criteria ◽  
Added Value ◽  
Combination Therapies ◽  
Pricing And Reimbursement

Introduction:Health technology assessment (HTA) must adapt to support the changing health system landscapes and improve access to valuable innovation under budgetary constraints. This is exemplified by the pricing and reimbursement of high-cost combination therapies increasingly used in oncology. Variability exists in current HTA practices across different countries, resulting in discrepancies in reimbursement outcomes and patient access. Using Italy as a case study, the objective was to assess the challenges faced by HTA agencies in the negotiation of pricing and reimbursement of combination therapies.Methods:A targeted literature review of Italian HTA agency websites was undertaken to identify any literature/guidance relating to HTA decision-making for combination oncology therapies.Results:In Italy, there is no fixed cost-effectiveness threshold and decisions are based on multiple criteria. Managed market entry agreements are extensively used; price-volume agreements and drug registries are common. While this framework allows flexibility and avoids the rigidity of incremental cost-effectiveness ratio thresholds, it has raised concerns about transparency and budget impact. Combination therapies are not given specific concessions; however, market access for a combination of a new high-cost drug with an existing one is complex, particularly if the drugs are manufactured by different companies. The added value provided by the new drug in the combination should be rewarded while the older product benefits from the increased volume of use. The price of the older drug cannot be lowered unless the pricing and reimbursement contract is expiring or a new indication/formulation is pending, presenting a challenge to both pharmaceutical companies and HTA agencies.Conclusions:Combination therapies pose a challenge for HTA agencies. In the Italian system this is partially mitigated by the use of multiple criteria for decision-making and managed access agreements. However, these approaches have also led to concerns about a lack of transparency in decision-making.

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