Abstract
The ‘conventional framework’ of economic evaluation, the comparative public sector healthcare costs and quality adjusted life year (QALY) of two or more interventions, has become synonymous with commissioning decisions in many countries. However, while useful as a framework in guiding value-based decisions, it has limited relevance in areas such as end of life care in children and young people, where the costs fall across multiple stakeholders and QALY gains are not the primary outcome. This paper makes the case that the restricted relevance of the ‘conventional framework’ has contributed to the inconsistent and varied provision of care in this setting, and to the knock-on detrimental impact on children nearing the end of their lives as well as their families. We explore the challenges faced by those seeking to conduct economic evaluations in this setting alongside some potential solutions. We conclude that there is no magic bullet approach that will amalgamate the ‘conventional framework’ with the requirements of a meaningful economic evaluation in this setting. However, this does not imply a lack of need for the summation of the costs and outcomes of care able to inform decision makers, and that methods such as impact inventory analysis may facilitate increased flexibility in economic evaluations.
Highlights
Accepted: 2 November 2021Economic evaluation methods of cost-effectiveness analysis have become synonymous with the deliberative process of health technology agencies such as the National Institute for Health and Care Excellence (NICE) in England
Its exclusion erodes the role of accountability, demonstration of patient benefit, and the explicit consideration of the opportunity cost of investment, or lack of it, in the decision-making process [1]. These factors contribute to the inconsistent and varied provision of services which is evident in paediatric palliative and end of life care [15], and exactly the issues which agencies such as NICE was first created to address [16]
The approach taken in these NICE evaluations is indicative of the wider published end of life care literature, with Mathew et al showing that, of 52 economic evaluations, 43 were solely costing studies which did not consider any form of outcome [11]
Summary
Its exclusion erodes the role of accountability, demonstration of patient benefit, and the explicit consideration of the opportunity cost of investment, or lack of it, in the decision-making process [1] These factors contribute to the inconsistent and varied provision of services which is evident in paediatric palliative and end of life care [15], and exactly the issues which agencies such as NICE was first created to address [16].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International Journal of Environmental Research and Public Health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
