Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-25T06:55:22.369Z Has data issue: false hasContentIssue false
  • English
  • Français

Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations

Published online by Cambridge University Press:  20 April 2018

Rachel Meacock
Rachel Meacock*
Affiliation:
Research Fellow in Health Economics, Manchester Centre for Health Economics, The University of Manchester, Manchester,UK
*
*Correspondence to: Rachel Meacock, Research Fellow in Health Economics, Manchester Centre for Health Economics, The University of Manchester, 4.311 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

There is a requirement for economic evaluation of health technologies seeking public funding across Europe. Changes to the organisation and delivery of health services, including changes to health policy, are not covered by such appraisals. These changes also have consequences for National Health Service (NHS) funds, yet undergo no mandatory cost-effectiveness assessment. The focus on health technologies may have occurred because larger-scale service changes pose more complex challenges to evaluators. 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 five principal challenges identified are as follows: undertaking ex-ante evaluation; evaluating impacts in terms of quality-adjusted life years; assessing costs and opportunity costs; accounting for spillover effects; and generalisability. Of these challenges, methods for estimating the impact on costs and quality-adjusted life years are those most in need of development. Methods are available for ex-ante evaluation, assessing opportunity costs and examining generalisability. However, these are rarely applied in practice. 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.

Type
Perspective
Information
Health Economics, Policy and Law , Volume 14 , Issue 1 , January 2019 , pp. 119 - 134
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, R. and Hardwick, R. (2016), ‘Realism and resources: towards more explanatory economic evaluation’, Evaluation, 22: 323–341.Google Scholar
Appleby, J. (2016), ‘A 7/7 NHS: what price equity?’, BMJ, 352: i404.Google Scholar
Asaria, M., Griffin, S. and Cookson, R. (2016), ‘Distributional cost-effectiveness analysis’, Medical Decision Making, 36: 8–19.Google Scholar
Barratt, H., Campbell, M., Moore, L., Zwarenstein, M. and Bower, P. (2016), ‘Randomised controlled trials of complex interventions and large-scale transformation of services’, in R. Raine, R. Fitzpatrick, H. Barratt, G. Bevan, N. Black, R. Boaden, et al. (eds), Challenges, solutions and future directions in the evaluation of service innovations in health care and public health, Health Services Delivery Research, 4(16): 19–36.Google Scholar
Claxton, K., Martin, S., Soares, M., Rice, N., Spackman, E., Hinde, S., Devlin, N., Smith, P. and Sculpher, M. (2015), ‘Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold’, Health Technology Assessment, 19: 1–503.Google Scholar
Congressional Budget Office (2007), ‘CBO’s Health Insurance Simulation Model: A Technical Description’, Congressional Budget Office, Washington, DC.Google Scholar
Department of Health (2008), ‘Guidance on the routine collection of patient reported outcome measures (PROMs)’, Department of Health, London.Google Scholar
Drummond, M., Griffin, A. and Tarricone, R. (2009), ‘Economic evaluation for devices and drugs – same or different?’, Value of Health, 12: 402–404.Google Scholar
Drummond, M., Sculpher, M., Claxton, K., Stoddart, G. and Torrance, G. (2015), Methods for the Economic Evaluation of Health Care Programmes, 4th edn, Oxford: Oxford University Press Inc.Google Scholar
Finkelstein, A. and Taubman, S. (2015), ‘Randomize evaluations to improve health care delivery’, Science, 347: 720–722.Google Scholar
Gillies, C., Freemantle, N., Grieve, R., Sekhon, J. and Forder, J. (2016), ‘Advancing quantitative methods for the evaluation of complex interventions’, in R. Raine, R. Fitzpatrick, H. Barratt, G. Bevan, N. Black, R. Boaden, et al. (eds), Challenges, solutions and future directions in the evaluation of service innovations in health care and public health, Health Services Delivery Research, 4(16): 37–54.Google Scholar
Gomes, M., Gutacker, N., Bojke, C. and Street, A. (2016), ‘Addressing missing data in patient‐reported outcome measures (PROMS): implications for the use of PROMS for comparing provider performance’, Health Economics, 25: 515–528.Google Scholar
Graves, N., Walker, D., Raine, R., Hutchings, A. and Roberts, J.A. (2002), ‘Cost data for individual patients included in clinical studies: no amount of statistical analysis can compensate for inadequate costing methods’, Health Economics, 11: 735–739.Google Scholar
Hunter, R. M., Davie, C., Rudd, A., Thompson, A., Walker, H., Thomson, N., Mountford, J., Schwamm, L., Deanfield, J., Thompson, K., Dewan, B., Mistry, M., Quoraishi, S. and Morris, S. (2013), ‘Impact on clinical and cost outcomes of a centralized approach to acute stroke care in London: a comparative effectiveness before and after model’, PLoS One, 8: e70420.Google Scholar
Kristensen, S., Meacock, R. and Sutton, M. (2015), ‘Methodology for Modelling Changes in Health Services Delivery and Policy’, Vignette prepared for the MRC-NIHR Methodology Research Programme Advisory Group, London.Google Scholar
Lamont, T., Barber, N., Pury, J., de, Fulop, N., Garfield-Birkbeck, S., Lilford, R., Mear, L., Raine, R. and Fitzpatrick, R. (2016), ‘New approaches to evaluating complex health and care systems’, BMJ, 352: i154.Google Scholar
Lilford, R. J., Chilton, P. J., Hemming, K., Girling, A. J., Taylor, C. A. and Barach, P. (2010), ‘Evaluating policy and service interventions: framework to guide selection and interpretation of study end points’, BMJ, 341: c4413.Google Scholar
Maynard, A. (2012), ‘The powers and pitfalls of payment for performance’, Health Economics, 21: 3–12.Google Scholar
Meacock, R., Kristensen, S. R. and Sutton, M. (2014), ‘The cost-effectiveness of using financial incentives to improve provider quality: a framework and application’, Health Economics, 23: 1–13.Google Scholar
Meacock, R., Doran, T. and Sutton, M. (2015), ‘What are the costs and benefits of providing comprehensive seven-day services for emergency hospital admissions?’, Health Economics, 24: 907–912.Google Scholar
Meacock, R., Sutton, M., Kristensen, S. R. and Harrison, M. (2016), ‘Using survival analysis to improve estimates of life year gains in policy evaluations’, Medical Decision Making 37(4): 415–426.Google Scholar
Medical Research Council (2008), ‘Developing and evaluating complex interventions: new guidance’, Medical Research Council, London.Google Scholar
Medical Research Council (2009), ‘Using natural experiments to evaluate population health interventions: guidance for producers and users of evidence’, Medical Research Council, London.Google Scholar
National Institute for Health and Care Excellence (NICE) (2013), Guide to the methods of technology appraisal 2013. The-reference-case, https://www.nice.org.uk/article/pmg9/chapter/the-reference-case [31 March 2016].Google Scholar
National Institute for Health and Care Excellence (NICE) (2014), Guide to the processes of technology appraisal, https://www.nice.org.uk/process/pmg19/chapter/introduction [30 November 2016].Google Scholar
Raine, R., Fitzpatrick, R., Barratt, H., Bevan, G., Black, N., Boaden, R., Bower, P., Campbell, M., Denis, J.-L., Devers, K., Dixon-Woods, M., Fallowfield, L., Forder, J., Foy, R., Freemantle, N., Fulop, N. J., Gibbons, E., Gillies, C., Goulding, L., Grieve, R., Grimshaw, J., Howarth, E., Lilford, R. J., McDonald, R., Moore, G., Moore, L., Newhouse, R., O’Cathain, A., Or, Z., Papoutsi, C., Prady, S., Rycroft-Malone, J., Sekhon, J., Turner, S., Watson, S.I. and Zwarenstein, M. (2016), ‘Challenges, solutions and future directions in the evaluation of service innovations in health care and public health’, Health Services and Delivery Research, NIHR Journals Library, Southampton.Google Scholar
Reed Johnson, F. (2009), ‘Editorial: moving the QALY forward or just stuck in traffic?’, Value in Health, 12: S38–S39.Google Scholar
Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., Kuntz, K. M., Meltzer, D. O., Owens, D. K., Prosser, L. A., Salomon, J. A., Sculpher, M. J., Trikalinos, T. A., Russell, L. B., Siegel, J. E. and Ganiats, T. G. (2016), ‘Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine’, JAMA, 316: 1093–1103.Google Scholar
Shah, K., Praet, C., Devlin, N., Sussex, J., Appleby, J. and Parkin, D. (2012), ‘Is the aim of the English health care system to maximize QALYs?’, Journal of Health Services Research & Policy, 17: 157–163.Google Scholar
Shiell, A., Hawe, P. and Gold, L. (2008), ‘Complex interventions or complex systems? Implications for health economic evaluation’, BMJ, 336: 1281–1283.Google Scholar
Smith, M. D., Drummond, M. and Brixner, D. (2009), ‘Moving the QALY forward: rationale for change’, Value in Health, 12: S1–S4.Google Scholar
Sutton, M., Elder, R., Guthrie, B. and Watt, G. (2010), ‘Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers’, Health Economics, 19: 1–13.Google Scholar
Tunis, S. R., Stryer, D. B. and Clancy, C. M. (2003), ‘Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy’, JAMA, 290: 1624–1632.Google Scholar
Turner, S., Goulding, L., Denis, J.-L., McDonald, R. and Fulop, N. J. (2016), ‘Major system change: a management and organisational research perspective’, in R. Raine, R. Fitzpatrick, H. Barratt, G. Bevan, N. Black, R. Boaden, et al. (eds), Challenges, solutions and future directions in the evaluation of service innovations in health care and public health, Health Services Delivery Research, 4(16): 85–104.Google Scholar
Yao, G. L., Novielli, N., Manaseki-Holland, S., Chen, Y.-F., Klink, M., van der, Barach, P., Chilton, P. J. and Lilford, R. J. (2012), ‘Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers’, BMJ Quality & Safety, 21: i29–i38.Google Scholar