Reduce Harm and Waste - Cost Effectiveness & Economic Analysis

The approach to Reducing Harm and Waste in Realistic Medicine is to focus on value. When resources are limited, interventions are offered to those who will benefit most and who are more willing to accept risk and in these conditions it is more likely that high value healthcare is delivered. However as resources increase, interventions are offered to those less likely to benefit while the likelihood and magnitude of harm stays the same and in these conditions it is more likely that low or negative value healthcare is delivered. A personalised approach to care can help communicate these concepts for patients and help understand what benefit and risk mean for a patient’s personal situation. Personalised care can also reduce the impact of adverse events. Being Open is a best practice framework used in Scotland which creates an environment where patients and families feel supported and healthcare professionals and managers have the confidence to act appropriately. “Psychological harm to families is reduced when they experience compassionate care, their perspective is valued and when they are central to the review of care.” Being Open has also been used to prevent future harm when staff participate with the learning and improvement generated from the adverse event review reports. [The Scottish Government. Personalising Realistic Medicine: Chief Medical Officer for Scotland’s Annual Report 2017-18. Published 2019. https://www.gov.scot/publications/personalising-realistic-medicine-chief-medical-officer-scotland-annual-report-2017-2018/pages/7/]

Value can be assessed in many different ways and can include cost-effectiveness analysis, economic analysis, disinvestment, and reducing overuse and overprescribing. Below is a selection of recent journal articles and reports which are about cost effectiveness or economic analysis in healthcare.  If you are looking to answer a specific question please submit a literature search request at the link above.  If you would like to be alerted when new content is available here then please sign in and select Follow.  You are welcome to leave comments and suggestions below in the comments section.

DA SILVA ETGES A.P.B., et al, 2019. An 8-step framework for implementing time-driven activity-based costing in healthcare studies. European Journal of Health Economics, 20(8), pp. 1133-1145.
This article aimed at exploring the literature and practical cases to propose an eight-step framework to apply TDABC in micro-costing studies for health care organizations. The 8-step TDABC framework is presented and detailed exploring online spreadsheets already coded to demonstrate data structure and math formula building. A list of analyses that can be performed is suggested, including an explanation about the information that each analysis can provide to increase the organization capability to orient decision making. The case study developed show that actual micro-costing of health care processes can be achieved with the 8-step TDABC framework and its use in future researches can contribute to increase the number of studies that achieve high-quality level in cost information, and consequently, in health resource evaluation.

HEALTH FINANCIAL MANAGEMENT ASSOCIATION, 2019. NHS efficiency map.
This map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) and quality, innovation, production and prevention (QIPP) schemes in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency.

Hernandez-Villafuerte, K., Zamora, B., Feng, Y., et al.  Exploring variations in the opportunity cost cost-effectiveness threshold by clinical areas: results from a feasability study in England.  Office of Health Economics, March 2019.  Estimating a cost-effectiveness threshold reflecting the opportunity cost of adopting a new technology in a health system is not easy.  This OHE research paper provides empirical evidence on the relationship between health outcomes and health expenditures in England.  Results suggest that setting a cost-effectivess criterion for NICE may not be capable of being syntehsised using scientific methods alone, but involve political judgements.

MEACOCK, R., 2019. Methods for the economic evaluation of changes to the organisation and delivery of health services : principal challenges and recommendations. Health Economics, Policy and Law, 14(1), pp. 119-134. This paper discusses the principal challenges faced when performing economic evaluations of changes to the organisation and delivery of health services and provides recommendations for overcoming them. The general principles of assessing the cost-effectiveness of interventions should be applied to all NHS spending, not just that involving health technologies. Advancements in this area have the potential to improve the allocation of scarce NHS resources.

Briggs, ADM., Scarborough, P.  Wolstenholme, J. (2018) Estimating comparable English healthcare costs for multiple diseases and unrelated future costs for use in health and public health economic modelling.  PLoS ONE 13(5): e0197257. The methodology described allows health and public health economic modellers to estimate comparable English healthcare costs for multiple diseases.  This facilitates the direct comparison of different health and public health interventions enabling better decision making.

Harris, A., Sharma, A.(2018)  Estimating the future health and aged care expenditure in Australia with changes in morbidity.  PLoS ONE 13(5): e0201697.  Ageing will have a direct effect on the growth of health spending but is likely to be dwarfed  by other demand and supply factors.  A focus on greater efficiency in health production and finance is likely to be more effective in delivering high quality care than trying to restrain the damand for health and aged care among the elderly,

Pandya, A., Doran, T., Zhu, J., et al. (2018)  Modelling the cost-effectiveness of pay for performance in primary care in the UK.  BMC Medicine 16(1): 135, 2018 09 29. Compared to stopping the Quality Outcomes Framework (QOF) and returnign all associated incentive payments to the National Health Service, continuing the QQOF  is not cost-effective.  To improve population health efficiently, the UK should redesign the QOF or pursuue alternative interventions.

Timka, T., Nyce, JM., Amer-Wahlin, I. (2018) Value-based reimbursement in collectively financed healthcare requires monitoring of socioeconomic patient data to maintain equality in service provision.  Journal of General Internal Medicine  September 11th.  Value-based purchasing is increasingly discussed in association with efforts to develop modern healthcare systems.  These models are hte most recent example of models derived frmo health economics research intended to reform collectively financed healthcare.  Previous examples have ranged from creation of pseudo-marjets to opening these markets for competition between publicly and privately owned enterprises.  Most value-based purchasing models tend to ignore that health service provision in collectively financed settings is based on an insurance with political, social obligations attached that challenge the notion of free market and individualist premises which these models rest on.  Central social issues related to healthcare in any modern complex society, such as inequality in service provision, can all too easily "disappear" in value-based reform efforts.  Based on an analysis of Swedish policy development, the authors content that managemnet information systems need to be extended to allow routine monitoring of socioeconomic data when models such as value-based purchasing are introduced in collectively financed health services.  The experiences from Sweden are important for health policy in Europe and other regions with collectively financed healthcare plans.