The Value of Health in a Cost-Effectiveness Analysis: Theory Versus Practice

Wouterse, Bram; Baal, Pieter van; Versteegh, Matthijs; Brouwer, Werner

doi:10.1007/s40273-023-01265-8

Cited by 11 publications

(1 citation statement)

References 49 publications

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“…Importantly this is only one, and not necessarily the best, way to deliver the payments required for dynamic efficiency. Nonetheless, we choose to illustrate the implications for this particular mechanism of payment as the question of appropriate approval norms has been widely discussed in the HTA literature (Brouwer, van Baal, van Exel, & Versteegh, 2019;McCabe et al, 2008;Wouterse, van Baal, Versteegh, & Brouwer, 2023).…”

Section: Payment Approval Norms and Application To Nice Appraisalsmentioning

confidence: 99%

Achieving dynamic efficiency in pharmaceutical innovation: Identifying the optimal share of value and payments required

Woods,

Lomas,

Sculpher

et al. 2024

Health Economics

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It has been argued that cost‐effectiveness analysis of branded pharmaceuticals only considers static efficiency, neglects dynamic effects and undermines incentives for socially valuable innovation. We present a framework for designing pharmaceutical pricing policy to achieve dynamic efficiency. We develop a coherent framework that identifies the long‐term static and dynamic benefits and costs of offering manufacturers different levels of reward. The share of value that would maximise long‐term population health depends on how the quantity and quality of innovation responds to payment. Using evidence of the response of innovation to payment, the optimal share of value of new pharmaceuticals to offer to manufacturers is roughly 20% (range: 6%–51%). Reanalysis of a sample of NICE technology appraisals suggests that, in most cases, the share of value offered to manufacturers and the price premium paid by the English NHS were too high. In the UK, application of optimal shares would offer considerable benefits under both a public health objective and a broader view of social welfare. We illustrate how an optimal share of value can be delivered through a range of payment mechanisms including indirect price regulation via the use of different approval norms by an HTA body.

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Section: Payment Approval Norms and Application To Nice Appraisalsmentioning

confidence: 99%

Achieving dynamic efficiency in pharmaceutical innovation: Identifying the optimal share of value and payments required

Woods,

Lomas,

Sculpher

et al. 2024

Health Economics

View full text Add to dashboard Cite

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The impact of different perspectives on the cost-effectiveness of remote patient monitoring for patients with heart failure in different European countries

Mokri,

van Baal,

Rutten-van Mölken

2024

Eur J Health Econ

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Background and objective Heart failure (HF) is a complex clinical syndrome with high mortality and hospitalization rates. Non-invasive remote patient monitoring (RPM) interventions have the potential to prevent disease worsening. However, the long-term cost-effectiveness of RPM remains unclear. This study aimed to assess the cost-effectiveness of RPM in the Netherlands (NL), the United Kingdom (UK), and Germany (DE) highlighting the differences between cost-effectiveness from a societal and healthcare perspective. Methods We developed a Markov model with a lifetime horizon to assess the cost-effectiveness of RPM compared with usual care. We included HF-related hospitalization and non-hospitalization costs, intervention costs, other medical costs, informal care costs, and costs of non-medical consumption. A probabilistic sensitivity analysis and scenario analyses were performed. Results RPM led to reductions in HF-related hospitalization costs, but total lifetime costs were higher in all three countries compared to usual care. The estimated incremental cost-effectiveness ratios (ICERs), from a societal perspective, were €27,921, €32,263, and €35,258 in NL, UK, and DE respectively. The lower ICER in the Netherlands was mainly explained by lower costs of non-medical consumption and HF-related costs outside of the hospital. ICERs, from a healthcare perspective, were €12,977, €11,432, and €11,546 in NL, the UK, and DE, respectively. The ICER was most sensitive to the effectiveness of RPM and utility values. Conclusions This study demonstrates that RPM for HF can be cost-effective from both healthcare and societal perspective. Including costs of living longer, such as informal care and non-medical consumption during life years gained, increased the ICER.

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Benefits beyond health in the willingness to pay for a quality-adjusted life-year

de Vries,

Brouwer,

van Baal

2024

Eur J Health Econ

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Adopting a societal perspective in cost-effectiveness analysis (CEA) requires including all societal costs and benefits even if they fall outside of the realm of health and healthcare. While some benefits are not explicitly included, they might be implicitly included when people value quality-adjusted life-years (QALYs) in monetary terms. An example is utility of consumption (UoC) which has played a crucial role in discussions regarding the welfare economic underpinnings of CEA. This study investigates whether people consider elements beyond health when valuing QALYs monetarily and the influence of inclusion on this value. A Willingness to Pay (WTP) experiment was administered among the general public in which people were asked to assign monetary values to QALYs. Our results show that (stated) UoC increases with quality of life but that instructing people to consider UoC does not impact their monetary valuation of the QALY. Furthermore, many respondents consider elements beyond health when valuing QALYs but the impact on the monetary value of a QALY is limited. These findings suggest that these elements are currently not (adequately) captured in CEA. Findings also illustrate that it is difficult to isolate health from non-health benefits and to consistently capture these in CEA. With that, reconciling CEA with welfare economics remains challenging.

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The Value of Health in a Cost-Effectiveness Analysis: Theory Versus Practice

Cited by 11 publications

References 49 publications

Achieving dynamic efficiency in pharmaceutical innovation: Identifying the optimal share of value and payments required

Achieving dynamic efficiency in pharmaceutical innovation: Identifying the optimal share of value and payments required

The impact of different perspectives on the cost-effectiveness of remote patient monitoring for patients with heart failure in different European countries

Benefits beyond health in the willingness to pay for a quality-adjusted life-year

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