Economic Evaluation Of Prevention Research Articles

SA6 A Review of Economic Evaluation on Vaccination and Non-Pharmaceutical Interventions for COVID-19 Prevention and Control

SA6 A Review of Economic Evaluation on Vaccination and Non-Pharmaceutical Interventions for COVID-19 Prevention and Control

Health economic aspects of late preterm and early term birth

Despite an increasing body of knowledge on the adverse clinical sequelae associated with late preterm birth and early term birth, little is known about their economic consequences or the cost-effectiveness of interventions aimed at their prevention or alleviation of their effects. This review assesses the health economic evidence surrounding late preterm and early term birth. Evidence is gathered on hospital resource use associated with late preterm and early term birth, economic costs associated with late preterm and early term birth, and economic evaluations of prevention and treatment strategies. The article highlights the limited perspective and time horizon of most studies of economic costs in this area; the limited evidence surrounding health economic aspects of early term birth; the gaps in current knowledge; and it discusses directions for future research in this area, including the need for validated tools for measuring preference-based health-related quality-of-life outcomes in infants that will aid cost-effectiveness-based decision-making.

Estimates and predictors of health care costs of esophageal adenocarcinoma: a population-based cohort study

BackgroundEsophageal adenocarcinoma (EAC) incidence is increasing rapidly. Esophageal cancer has the second lowest 5-year survival rate of people diagnosed with cancer in Canada. Given the poor survival and the potential for further increases in incidence, phase-specific cost estimates constitute an important input for economic evaluation of prevention, screening, and treatment interventions. The study aims to estimate phase-specific net direct medical costs of care attributable to EAC, costs stratified by cancer stage and treatment, and predictors of total net costs of care for EAC.MethodsA population-based retrospective cohort study was conducted using Ontario Cancer Registry-linked administrative health data from 2003 to 2011. The mean net costs of EAC care per 30 patient-days (2016 CAD) were estimated from the payer perspective using phase of care approach and generalized estimating equations. Predictors of net cost by phase of care were based on a generalized estimating equations model with a logarithmic link and gamma distribution adjusting for sociodemographic and clinical factors.ResultsThe mean net costs of EAC care per 30 patient-days were $1016 (95% CI, $955–$1078) in the initial phase, $669 (95% CI, $594–$743) in the continuing care phase, and $8678 (95% CI, $8217–$9139) in the terminal phase. Overall, stage IV at diagnosis and surgery plus radiotherapy for EAC incurred the highest cost, particularly in the terminal phase. Strong predictors of higher net costs were receipt of chemotherapy plus radiotherapy, surgery plus chemotherapy, radiotherapy alone, surgery alone, and chemotherapy alone in the initial and continuing care phases, stage III-IV disease and patients diagnosed with EAC later in a calendar year (2007–2011) in the initial and terminal phases, comorbidity in the continuing care phase, and older age at diagnosis (70–74 years), and geographic region in the terminal phase.ConclusionsCosts of care vary by phase of care, stage at diagnosis, and type of treatment for EAC. These cost estimates provide information to guide future resource allocation decisions, and clinical and policy interventions to reduce the burden of EAC.

Making the economic case for prevention – a view from Wales

BackgroundIt is widely acknowledged that adverse lifestyle behaviours in the population now will place an unsustainable burden on health service resources in the future. It has been estimated that the combined cost to the NHS in Wales of overweight and obesity, alcohol and tobacco is in excess of £540 million.In the current climate of financial austerity, there can be a tendency for the case for prevention efforts to be judged on the basis of their scope for cost savings. This paper was prompted by discussion in Wales about the evidence for the cost savings from prevention and early intervention and a resulting concern that these programmes were thus being evaluated in policy terms using an incorrect metric. Following a review of the literature, this paper contributes to the discussion of the potential role that economics can play in informing decisions in this area.DiscussionThis paper argues that whilst studies of the economic burden of diseases provide information about the magnitude of the problem faced, they should not be used as a means of priority setting. Similarly, studies discussing the likelihood of savings as a result of prevention programmes may be distorting the arguments for public health.Prevention spend needs to be considered purposefully, resulting in a strategic commitment to spending. The role of economics in this process is to provide evidence demonstrating that information and support can be provided cost effectively to individuals to change their lifestyles thus avoiding lifestyle related morbidity and mortality. There is growing evidence that prevention programmes represent value for money using the currently accepted techniques and decision making metrics such as those advocated by NICE.SummaryThe issue here is not one of arguing that the economic evaluation of prevention and early intervention should be treated differently, although in some instances that may be appropriate, rather it is about making the case for these interventions to be treated and evaluated to the same standard. The difficulty arises when a higher standard of cost saving may be expected from prevention and public health programmes.The paper concludes that it is of vital importance that during times of budget constraints, as currently faced, the public health budgets are not eroded to fund secondary care budget shortfalls, which are more easily identifiable. To do so would diminish any possibility of reducing the future burden faced by the NHS of lifestyle-related illnesses.

The economic evaluation of prevention – Let’s talk about values and the case of discounting

“Does prevention pay off?” is a question frequently directed at health economists, and, as they are economists, they usually respond “it depends”. The good news is that health economic evidence on prevention has steadily increased over the past years and a number of interventions have proven favourable cost-effectiveness ratios (Wang et al. 2001; Murray et al. 2003). The bad news is that this growth has been highly selective, and many of the studies lack quality. In a recent systematic review we found that the majority of economic evaluations that assessed interventions for primary prevention of cardiovascular disease are pharmacoeconomic studies of clinical prevention that target dyslipidemia and typically refer

Economic evaluation of prevention: we need to do better but first we need to sort out what the good is

Economic evaluation of prevention: we need to do better but first we need to sort out what the good is

The economics of primary prevention of cardiovascular disease - a systematic review of economic evaluations.

BackgroundIn the quest for public and private resources, prevention continues to face a difficult challenge in obtaining tangible public and political support. This may be partly because the economic evidence in favour of prevention is often said to be largely missing. The overall aim of this paper is to examine whether economic evidence in favour of prevention does exist, and if so, what its main characteristics, weaknesses and strengths are. We concentrate on the evidence regarding primary prevention that targets cardiovascular disease event or risk reduction.MethodsWe conducted a systematic literature review of journal articles published during the period 1995–2005, based on a comprehensive key-word based search in generic and specialized electronic databases, accompanied by manual searches of expert databases. The search strategy consisted of combinations of freetext and keywords related to economic evaluation, cardiovascular diseases, and primary preventive interventions of risk assessment or modification.ResultsA total of 195 studies fulfilled all of the relevant inclusion criteria. Overall, a significant amount of relevant economic evidence in favour of prevention does exist, despite important remaining gaps. The majority of studies were cost-effectiveness-analyses, expressing benefits as "life years gained", were conducted in a US or UK setting, assessed clinical prevention, mainly drugs targeted at lowering lipid levels, and referred to subjects aged 35–64 years old with at least one risk factor.ConclusionFirst, this review has demonstrated the obvious lack of economic evaluations of broader health promotion interventions, when compared to clinical prevention. Second, the clear role for government to engage more actively in the economic evaluation of prevention has become very obvious, namely, to fill the gap left by private industry in terms of the evaluation of broader public health interventions and regarding clinical prevention, in light of the documented relationship between study funding and reporting of favourable results. Third, the value of greater adherence to established guidelines on economic evaluation cannot be emphasised enough. Finally, there appear to be certain methodological features in the practice of economic evaluations that might bias the choice between prevention and cure in favour of the latter.

The discount rate in the economic evaluation of prevention: a thought experiment

OBJECTIVESIn the standard economic model of evaluation, constant discount rates devalue the long term health benefits of prevention strongly. This study shows that it is unlikely that this reflects societal...

Using Cost-Effectiveness/Cost- Benefit Analysis to Allocate Health Resources: A Level Playing Field for Prevention?

Prevention is being promoted as a means to improve health status and to save health care costs. Economic evaluations of prevention (i.e., cost-effectiveness and cost-benefit analyses) indicate that some prevention activities, like many treatments, do not save money, although many are relatively cost-effective. It has been suggested, however, that prevention is held to a higher standard than treatment because prevention programs are expected to demonstrate cost savings, and that the methods of economic evaluation understate the cost-effectiveness of prevention. Although the converse assertion is less commonly made, economic evaluations may also overstate the cost-effectiveness of prevention. The purpose of this article is to examine how the methods of economic evaluation may systematically understate, or overstate, the cost-effectiveness (or net benefits) of prevention. We examine three key methods: (1) how future costs and benefits are valued ("discounting"), (2) how costs and benefits to people beyond those who are the users of prevention are valued ("externalities"), and (3) how nonmonetary costs and benefits to individuals are valued ("intangibles"). We discuss several recommendations for each key method, and we use a hypothetical example of the cost-effectiveness of a vaccine to prevent human immunodeficiency virus (HIV) to illustrate our points. We conclude that the methods of economic evaluation may both understate and overstate the cost-effectiveness of prevention.