Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters?

Abstract

BackgroundThe allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008) and the disease burden in the population.MethodsElectronic databases (e.g., PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS) and reports from health technology assessment agencies were systematically reviewed. For each article, multiple variables were recorded such as: year and journal of publication, type of study, health intervention targetted, perspective of analysis, type of costs and sources of information, first author's affiliation, explicit recommendations aimed at decision-making, and the main disease cause to which the intervention was addressed. The following disease burden measures were calculated: years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and mortality by cause. Correlation and linear regression models were fitted.ResultsFour hundred and seventy-seven economic evaluations were identified. Cardiovascular diseases (15.7%), infectious diseases (15.3%), malignant neoplasms (13.2%), and neuropsychiatric diseases (9.6%) were the conditions most commonly addressed. Accidents and injuries, congenital anomalies, oral conditions, nutritional deficiencies and other neoplasms were the categories with a lowest number of studies (0.6% for each of them). For the main disease categories (n = 20), a correlation was seen with: mortality 0.67 (p = 0.001), DALYs 0.63 (p = 0.003), YLLs 0.54 (p = 0.014), and YLDs 0.51 (p = 0.018). By disease sub-categories (n = 51), the correlations were generally low and non statistically significant.ConclusionsExamining discrepancies between economic evaluations in particular diseases and the overall burden of disease helps shed light on whether there are potentially over- and under-investigated areas. The approach taken could help policy-makers understand whether resources for economic evaluation are being allocated by using summary measures of population health.

Evaluating New Health Technologies and Disease Burden in Developed Countries

“…Our analyses focused only on the main indications matched with the categories of the disease classification system defined in the Global Burden of Disease (GBD) study, whereas Martino and colleagues focused on all therapeutic indications for a technology (e.g., each of the multiple different indications for a monoclonal antibody were considered as equally significant), which may not always be representative of innovation. The authors correctly observe, as we have previously documented in cost-effectiveness research [6], that disaggregating broader categories into specific diseases further weakened the association. We believe that the most important issue of Martino and colleagues' study, however, is that there is some reason to believe that more misclassification has occurred, particularly among "other" subcategories (e.g., "other cardiovascular diseases" and "other malignant neoplasms") than in broader categories.…”

“…Overall, they suggest a weak association between innovation and disease burden in terms of disability-adjusted life-years (DALYs). Nonetheless, the article raised several issues but failed to cite some relevant articles published in the last 5 years in this field [2][3][4][5][6][7].…”

Does global drug innovation correspond to burden of disease? The neglected diseases in developed and developing countries

“…The second limitation relates to the scope of the studies that restrict their analysis to therapeutic indications or disease areas (Lichtenberg, 2005;Martino et al, 2012) and/or groups of countries (Catalá-López et al, 2010;Catalá-López et al, 2011;Kaplan et al, 2013;Kaplan & Laing, 2004;Neumann et al, 2005). By focusing on the United States and Europe, these studies fail to capture disease burden associated with diseases affecting low and middle-income countries and, therefore, present a narrow picture of global inequalities.…”

Do economic evaluation studies inform effective healthcare resource allocation in Iran? A critical review of the literature

“…Economic evaluation is commonly used as a decision tool in health care systems where, due to resource constrains, policy-makers have to choose between alternative activities with different implications for resources allocation [2]. …”