Healthcare Resource Allocation Decisions Research Articles

Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes?

In the aftermath of the Coronavirus disease 2019 (Covid-19) pandemic, allocation of non-urgent medical interventions is a persistent ethical challenge as health systems currently face an unprecedented backlog of patients requiring treatment. Difficult decisions must be made that prioritise certain patients over others. Ethical resource allocation requires that the needs of all patients are considered properly, but at present there is no guidance that can help support such decision-making which explicitly considers the needs of children with chronic and complex conditions. This paper reviews the NHS guidance for priorities and operational planning and examines how the needs of children with chronic illness are addressed in NHS objectives for restoring services and meeting elective care demands. The usual criteria for prioritisation featured in the NHS guidance fail to account for the distinct needs of children with chronic illnesses and fail to match more general considerations of what constitutes fair resource allocation decisions. To address this issue, two considerations, namely 'protecting age-related opportunity' and 'recognising complexity of care,' are proposed as additions to the existing approach. By providing a broader conception of needs, these criteria address inefficiencies of the current guidance and relevant ethical frameworks and help to embed a currently missing children-related ethical approach to healthcare policy making in general.

What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings.

Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

A systematic review of whole disease models for informing healthcare resource allocation decisions.

Whole disease models (WDM) are large-scale, system-level models which can evaluate multiple decision questions across an entire care pathway. Whilst this type of model can offer several advantages as a platform for undertaking economic analyses, the availability and quality of existing WDMs is unknown. This systematic review aimed to identify existing WDMs to explore which disease areas they cover, to critically assess the quality of these models and provide recommendations for future research. An electronic search was performed on multiple databases (MEDLINE, EMBASE, the NHS Economic Evaluation Database and the Health Technology Assessment database) on 23rd July 2023. Two independent reviewers selected studies for inclusion. Study quality was assessed using the National Institute for Health and Care Excellence (NICE) appraisal checklist for economic evaluations. Model characteristics were descriptively summarised. Forty-four WDMs were identified, of which thirty-two were developed after 2010. The main disease areas covered by existing WDMs are heart disease, cancer, acquired immune deficiency syndrome and metabolic disease. The quality of included WDMs is generally low. Common limitations included failure to consider the harms and costs of adverse events (AEs) of interventions, lack of probabilistic sensitivity analysis (PSA) and poor reporting. There has been an increase in the number of WDMs since 2010. However, their quality is generally low which means they may require significant modification before they could be re-used, such as modelling AEs of interventions and incorporation of PSA. Sufficient details of the WDMs need to be reported to allow future reuse/adaptation.

Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes?

Background: In the aftermath of the Coronavirus disease 2019 (Covid-19) pandemic, allocation of non-urgent medical interventions is a persistent ethical challenge as health systems currently face an unprecedented backlog of patients requiring treatment. Difficult decisions must be made that prioritise certain patients over others. Ethical resource allocation requires that the needs of all patients are considered properly, but at present there is no guidance that can help support such decision-making which explicitly considers the needs of children with chronic and complex conditions. Methods: This paper reviews the NHS guidance for priorities and operational planning and examines how the needs of children with chronic illness are addressed in NHS objectives for restoring services and meeting elective care demands. Results: The usual criteria for prioritisation featured in the NHS guidance fail to account for the distinct needs of children with chronic illnesses and fail to match more general considerations of what constitutes fair resource allocation decisions. To address this issue, two considerations, namely 'protecting age-related opportunity' and 'recognising complexity of care,' are proposed as additions to the existing approach. Conclusion: By providing a broader conception of needs, these criteria address inefficiencies of the current guidance and relevant ethical frameworks and help to embed a currently missing children-related ethical approach to healthcare policy making in general.

Using Age-Specific Values for Pediatric HRQoL in Cost-Effectiveness Analysis: Is There a Problem to Be Solved? If So, How?

Value sets for the EQ-5D-Y-3L published to date appear to have distinctive characteristics compared with value sets for corresponding adult instruments: in many cases, the value for the worst health state is higher and there are fewer values < 0. The aim of this paper is to consider how and why values for child and adult health differ; and what the implications of that are for the use of EQ-5D-Y-3L values in economic evaluations to inform healthcare resource allocation decisions. We posit four potential explanations for the differences in values: (a) The wording of severity labels may mean the worst problems on the EQ-5D-Y-3L are descriptively less severe than those on the EQ-5D-5L; (b) Adults may genuinely consider that children are less badly affected than adults by descriptively similar health issues. That is, for any given health problem, adult respondents in valuation studies consider children's overall health-related quality of life (HRQoL) on average to be higher than that for adults; (c) Values are being sought by eliciting adults' stated preferences for HRQoL in another person, rather than in themselves (regardless of whether the 'other person' concerned is a child); and (d) The need to elicit preferences for child HRQoL that are anchored at dead = 0 invokes special considerations regarding children's survival. Existing evidence does not rule out the possibility that (c) and (d) exert an upward bias in values. We consider the implications of that for the interpretation and use of values for pediatric HRQoL. Alternative methods for valuing children's HRQoL in a manner that is not 'age specific' are possible and may help to avoid issues of non-comparability. Use of these methods would place the onus on health technology assessment bodies to reflect any special considerations regarding child quality-adjusted life-year gains.

Informing a cost-effectiveness threshold for Saudi Arabia

Background Saudi Arabia’s Vision 2030 aims to reform health care across the Kingdom, with health technology assessment being adopted as one tool promising to improve the efficiency with which resources are used. An understanding of the opportunity costs of reimbursement decisions is key to fulfilling this promise and can be used to inform a cost-effectiveness threshold. This paper is the first to provide a range of estimates of this using existing evidence extrapolated to the context of Saudi Arabia. Methods and materials We use four approaches to estimate the marginal cost per unit of health produced by the healthcare system; drawing from existing evidence provided by a cross-country analysis, two alternative estimates from the UK context, and based on extrapolating a UK estimate using evidence on the income elasticity of the value of health. Consequences of estimation error are explored. Results Based on the four approaches, we find a range of SAR 42,046 per QALY gained (48% of GDP per capita) to SAR 215,120 per QALY gained (246% of GDP per capita). Calculated potential central estimates from the average of estimated health gains based on each source gives a range of SAR 50,000–75,000. The results are in line with estimates from the emerging literature from across the world. Conclusion A cost-effectiveness threshold reflecting health opportunity costs can aid decision-making. Applying a cost-effectiveness threshold based on the range SAR 50,000 to 75,000 per QALY gained would ensure that resource allocation decisions in healthcare can in be informed in a way that accounts for health opportunity costs. Limitations A limitation is that it is not based on a within-country study for Saudi Arabia, which represents a promising line of future work.

Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation

Abstract Background Atrial fibrillation (AF) is the most prevalent arrhythmia among adults worldwide and is associated with an increased risk of heart failure, stroke, and death. Prior studies have highlighted the healthcare burden associated with AF; however, contemporary data is lacking. As AF incidence and prevalence continue to increase due to the aging of the population, current estimates are needed for adequate healthcare resource allocation and policy decisions. Purpose The purpose of our study was to examine the healthcare utilization and cost burden associated with a diagnosis of incident AF in the United States (US). Methods Using the 2017–2020 Optum Clinformatics database, an administrative claims data of commercially insured individuals in the US, adult patients with an incident diagnosis of AF were identified. Adults with AF were matched on demographic and comorbid characteristics to those without AF using a propensity score greedy-matching algorithm with a 1:1 case to control ratio. Outcomes including medical services (inpatient admissions, emergency room [ER] visits, outpatients admissions, other services), utilization (all-cause, cardiovascular [CV]-related), and healthcare costs (sum of all medical services and prescription costs; adjusted for medical inflation and reported in 2021 US $) in the one-year post-incident diagnosis of AF were then compared among the matched cohort. Logistic and general linear modeling assessed healthcare utilization and cost outcomes. Results A total of 159,242 matched participants (79,621 AF cases and 79,621 non-AF controls) were identified. Among patients with AF, the mean age was 74 years, and 51% were females. Among the non-AF controls, the mean age was 73 years, and 50% were females. Patients with incident AF had significantly higher all-cause inpatient visits (relative risk [RR] 1.72; 95% confidence interval [CI]: 1.71–1.73), cardiovascular-related inpatient visits (RR 2.42; 95% CI: 2:41–2:44), as well as cardiovascular-related ER visits (RR: 2.36; 95% CI: 2:30–2:42) as compared to non-AF controls in the 1-year following diagnosis (Figure 1). The one-year mean total healthcare costs were $25,006 (95% CI $24,357-$26,912) higher among patients with AF as compared to non-AF controls ($63,031 vs $38,025, p&amp;lt;0.001). Conclusion Patients with AF had significantly higher medical services use than non-AF controls. The higher medical services utilization among the AF cohort translated into a considerably higher economic burden in this cohort. Timely management and treatment remain critical in alleviating the significant financial and health burden imposed by AF on patients, payers, and providers. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Johnson and Johnson

Hospital incidence and costs of congenital hydrocephalus in Spain: a multicenter retrospective study

Background Congenital hydrocephalus continues to represent a therapeutic challenge; however, few studies are available evaluating its hospital incidence and medical costs in Spain. This study aimed to review the profile of patients with this disorder admitted in Spanish hospitals and to estimate medical costs at the hospital level. Methods Records of hospital admissions of patients with congenital hydrocephalus between 2010 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. Results A third of the patients included in the study were perinatal patients, however, the hospitalization rate in this group was higher to that in patients over 1 year of age. Perinatal patients required more ICU admissions and longer hospital stays, with more frequent surgical interventions and mechanical ventilation. The mean medical cost associated to congenital hydrocephalus was €9610 per admission, with significantly higher costs found in perinatal patients. Conclusions This study provides novel data on the hospital costs of congenital hydrocephalus in Spain. The hospital medical costs of this disorder have decreased over the past decade for perinatal patients but not in those aged 1 year and older, which should be considered in upcoming healthcare plans and resource allocation decisions.

Cost-effectiveness of orthodontics: a systematic review.

Health economic evaluation is a methodology to maximize health benefits and minimize opportunity costs and is of increasing importance in informing resource allocation decisions in healthcare. This systematic review aims to assess the availability and quality of economic evaluations of any orthodontic interventions and summarize the conclusions of these studies. A thorough search of the literature was carried out including terms related to orthodontic interventions and economic evaluation between January 2000 and February 2022. MEDLINE, EMBASE, SCOPUS, Web of Science, NHS Economic Evaluation Database, and Cochrane were searched. Grey literature was searched and further hand-searching was performed on the reference lists of relevant systematic reviews. Studies on cleft lip and palate surgery and sleep apnoea were excluded due to the multi-disciplinary nature of these conditions which might alter the applicability of the result to orthodontic interventions. Two independent reviewers selected studies for inclusion. Data extraction was carried out through full text analysis of included studies by two authors. The quality of each study was assessed according to the Drummond 10-point Checklist and the National Institute for Health and Care Excellence (NICE) Quality Appraisal Checklist for Economic Evaluations. Characteristics and conclusions of included articles were descriptively summarized. Sixteen articles met inclusion criteria. Most of the included articles were trial-based studies, with only one model-based study. Orthodontic interventions assessed included crossbite correction, functional appliance treatment and orthognathic surgery. Most studies were carried out in Europe and specifically in Sweden. The quality of included studies was generally low with 69% of studies reported as having serious limitations according to the NICE Checklist. This review highlighted a lack of economic evaluations for orthodontic interventions, and limitations of existing economic evaluations. Recommendations on future research are provided. The protocol for the systematic review was registered on the NIHR Database (www.crd.york.ac.uk/prospero, CRD42021220419).

Mean lifetime survival estimates following solid organ transplantation in the US and UK

Aims Accurately estimating mean survival after solid organ transplant (SOT) is crucial for efficient healthcare resource allocation decisions. However, registry-based post-transplant recipient survival estimates vary greatly and are incomplete. Often, the methods used in lifetime survival extrapolation may not fit complex transplant data and therefore alternative methods are required. We aimed to explore the flexible cubic spline methodology as a meaningful alternative for estimating lifetime survival following SOT. Methods Survival analyses were conducted in kidney, liver, heart, and lung transplant recipients. Mean survival was estimated using flexible cubic splines on the hazard scale fitted with three knots, based on where hazards changed direction, clinical advice, and best-fit curve using Akaike and Bayesian information criterion. The tail was extrapolated when data were no longer available. Extrapolation tails were compared with general population mortality, using age-matched life table hazards, and the highest hazards were taken at all times. Results We found that mean survival post-transplant was longest for kidney transplants (US: 22.79 years; UK: 26.58 years), followed by liver (US: 20.90 years; UK: 20.38 years), heart (US: 14.82 years; UK: 15.85 years), and lung (US: 9.28 years; UK: 9.21 years). A sensitivity analysis using two knots found differences in survival ranging from −1.30 to +4.83 years across SOTs examined. Limitations This study does not represent individual patient survival, survival by age groups, multiple-organ transplants, or assess factors that may impact overall or organ survival. Conclusions Our study estimates reflect real-world survival following SOTs and demonstrate the importance of including long-term hazards in survival estimations. These lifetime survival estimates can be used by decision-makers in situations where means are preferred over medians (e.g. population projections, budgetary estimates, and cost-effectiveness models) and can thus offer a meaningful alternative to the estimates used and accepted in current practice.

A pharmacoeconomic evaluation of the pharmacotherapeutic options for painful diabetic neuropathy

ABSTRACT Introduction Painful diabetic neuropathy (PDN) is a high incidence and severe complication of diabetes mellitus, significantly compromising patients’ quality of life and causing tremendous economic burden. Considering drug costs becomes part of treatment decisions, with the growing choice of monotherapy or combination treatment strategies for PDN treatment. Areas covered This systematic review aims to identify the cost-effectiveness of pharmacotherapies in PDN, summarize key findings, and assess the quality of studies to inform healthcare resource allocation decisions and future research. Economic evaluations were identified by searching PubMed, Web of Science, Scopus and health technology assessment (HTA) databases, as well as screening reference lists of previously identified studies. Relevant data was extracted, and the CHEERS checklist was used to assess the quality of the studies. Expert opinion Collectively, the findings indicate that more pharmacoeconomics research is urgently needed to directly compare high-quality research for PDN combination medication/sequential treatment, and which is performed from a societal perspective. Simultaneously, to strengthen the reliability of the analysis, metrics such as adherence, incidence of adverse drug reactions, and pain levels utility value should be examined to verify the robustness of the basic results.

The effects of smoking, regular drinking, and unhealthy weight on health care utilization in China

BackgroundPreventive risk factors such as smoking, drinking, and unhealthy weight have contributed to the accelerated rise in noncommunicable chronic diseases, which are dominant drivers of health care utilization and spending in China. However, few studies have been conducted using a large longitudinal dataset to explore the impact of such preventive risk factors on health care utilization. Therefore, this study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on health care utilization in China.MethodsThis research was a longitudinal study using data from five waves of the China Family Panel Studies (CFPS) conducted between 2010 and 2018, and the final sample consisted of 63,260 observations (12,652 participants) across all five waves of data collection. Health care utilization was measured from two perspectives: outpatient utilization and inpatient utilization. Smoking status was categorized as never smoker, former smoker, or current smoker. Unhealthy weight was classified based on the participants’ body mass index. A fixed effects logistic regression model was used for the analysis.ResultsThe results of fixed effects logistic regression showed that current and former smokers were approximately 1.9 times and 2.0 times more likely to use outpatient care than those who never smoked, respectively (odds ratio (OR) = 1.88, p < 0.05; OR = 2.03, p < 0.05). Obese people were approximately 1.3 times more likely to use outpatient care than healthy weight people (OR = 1.26, p < 0.05). Moreover, the results show that compared to those who never smoked, for current and former smokers, the odds of being hospitalized increased by 42.2 and 198.2%, respectively (OR = 1.42; p < 0.1, OR = 2.98; p < 0.05). Compared to healthy weight people, overweight and obese people were also more likely to be hospitalized (OR = 1.11; p < 0.1, OR = 1.18; p < 0.1, respectively).ConclusionAmong Chinese adults, current and former smokers were more likely to use outpatient and inpatient care than those who had never smoked. Moreover, compared to healthy weight people, obese people were more likely to use outpatient and inpatient care, and overweight people were more likely to use inpatient care. These results may have important implications that support the government in making health care resource allocation decisions.

Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial.

Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control β 18.11 [95% CI -8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control β 1.24 [95% CI -6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker β -9.12 [95% CI -3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control β 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control β -0.12 [95% CI -0.54 to 0.30] p = 0.581; recommendation versus knowledge broker β -0.19 [-1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control β 2.19 [95% CI -1.36 to 5.74] p = 0.219; knowledge broker versus control β -0.55 [95% CI -1.16 to 0.06] p = 0.075; recommendation versus knowledge broker β -3.75 [95% CI -8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. Australian New Zealand Clinical Trials Registry ACTRN12618000029291.

PMS15 Assessing the Reporting Quality of Studies of Health Economic Evaluation Models in Osteoarthritis

Health economic evaluation models are increasingly used to compare alternative treatments and preventions for osteoarthritis (OA) to inform health care resource allocation decisions. Studies reporting economic evaluations are recommended to follow consistent and transparent reporting criteria to allow scrutiny of study findings, and ultimately, better health decisions. We aimed to assess the extent to which the existing reporting guidelines are adopted in model-based health economic evaluations (MHEEs) of OA interventions.

Willingness to pay for quality and length of life gains in end of life patients of different ages

Health gains are increasingly weighted in economic evaluations of new health technologies to guide resource-allocation decisions in healthcare. In Norway and the Netherlands weights are, for example, based on the disease severity of patients. In England and Wales, a higher weight is attached to quality-adjusted life-years (QALYs) gained from life-extending end-of-life (EOL) treatments. Societal preferences for QALY gains in EOL patients are increasingly examined. Although the available evidence suggests that gains in health-related quality of life (QOL) may be preferred to gains in life expectancy (LE), little is known about the influence of EOL patients’ age on these preferences. In this study, we examine the willingness to pay (WTP) for QOL and LE gains in EOL patients of different ages in a sample (n = 803) of the general public in the Netherlands. We found that WTP was relatively higher for QOL and LE gains in younger EOL patients. We further found indications suggesting that WTP may be relatively higher for QOL gains at the EOL, except for patients aged 20 for whom we observed a higher WTP for LE gains. Our results may inform discussions on attaching differential weights to QOL and LE gains in EOL patients of different ages with the objective to better align resource-allocation decisions with societal preferences.

Willingness to Pay for Health-Related Quality of Life Gains in Relation to Disease Severity and the Age of Patients

ObjectivesDecision-making frameworks that draw on economic evaluations increasingly use equity weights to facilitate a more equitable and fair allocation of healthcare resources. These weights can be attached to health gains or reflected in the monetary threshold against which the incremental cost-effectiveness ratios of (new) health technologies are evaluated. Currently applied weights are based on different definitions of disease severity and do not account for age-related preferences in society. However, age has been shown to be an important equity-relevant characteristic. This study examines the willingness to pay (WTP) for health-related quality of life (QOL) gains in relation to the disease severity and age of patients, and the outcome of the disease. MethodsWe obtained WTP estimates by applying contingent-valuation tasks in a representative sample of the public in The Netherlands (n = 2023). We applied random-effects generalized least squares regression models to estimate the effect of patients’ disease severity and age, size of QOL gains, disease outcome (full recovery/death 1 year after falling ill), and respondent characteristics on the WTP. ResultsRespondents’ WTP was higher for more severely ill and younger patients and for larger-sized QOL gains, but lower for patients who died. However, the relations were nonlinear and context dependent. Respondents with a lower age, who were male, had a higher household income, and a higher QOL stated a higher WTP for QOL gains. ConclusionsOur results suggest that—if the aim is to align resource-allocation decisions in healthcare with societal preferences—currently applied equity weights do not suffice.

Can We Incorporate Societal Values in Resource Allocation Decisions Among Disease Categories? An Empirical Approach

ObjectivesHistorically, resource allocation decisions in healthcare are based on univariate approaches, inevitably overlooking value dimensions that are essential from a societal welfare maximization perspective. This article aims to present a wider perspective on decision making that incorporates societal values when prioritizing future resource allocation among disease areas. MethodsSociotechnical application of multiple-criteria decision analysis with a set of criteria (value judgments) that are based on positive as well as normative dimensions of resource allocation. We use Greece as a case study. Societal value judgments were sourced via a multidisciplinary panel of experts who collectively provided criteria weights and scores for each alternative (16 disease categories, classified according to the Global Burden of Disease study) against each criterion. An additive value function provided the total value in priority preference for each alternative. ResultsThe criteria that were deemed relevant to the decision-making process and their respective relative weights were burden of disease (0.245), capacity to benefit (0.190), direct cost and projected changes in the next 5 years (0.160), indirect cost (0.132), intensity of unmet needs (0.109), incidence of catastrophic expenditure (0.091), and caring externalities (0.073). The additive value function revealed that the top 5 priorities in highest total value scores were neoplasms, circulatory diseases, injuries, neurologic diseases, and musculoskeletal diseases. ConclusionsIncorporation of societal value criteria in resource allocation decisions can highlight priorities and lead to different sets of planning decisions than solely demand-driven allocation.

Application of A Framework to Guide Policy on Healthcare Resource Allocation Decisions to Data Linkage Projects

IntroductionData linkage of population data sets often across jurisdictions or linking health data sets or health data with non-health data often involves balancing ethical principles such as privacy with beneficence as represented by the public good. Similar ethical dilemmas occur in health resource allocation decisions. The NHMRC have published a framework to guide policy on health resource allocation decisions that could be applied to ensure the justification of data linkage projects that is defensible as in the interest of the public good.&#x0D; Objectives and ApproachThe four main conditions for legitimacy of policy decisions about access to healthcare in a democracy with a public health system and limited resources wereexamined for their relevance to decisions about the use of public data and linking data sets.&#x0D; ResultsPublic policy decisions must be defensible and responsive to the interests of those affected. Decision-makers should articulate their reasoning and recommendations so that citizens can judge them. While the context of policy decisions will differ, their legitimacy depends upon (1) the transparency of the reasoning which should be free from conflicts of interest, the basis for decisions recorded and report widely, (2) the accountability of the decision-makers to the wider community, (3) the testability of the evidence used to inform the decision-making, which usually means that it will stand up to independent review and(4) the inclusive recognition of those the decision affects which often requires that the implications for disadvantaged groups are considered, even if they can’t always be accommodated. These conditions are interrelated but ensure that the good of society in general and not just specific dominant groups are accommodated.&#x0D; Conclusion / ImplicationsIt these principles are applied to decisions about data linkage projects they have clear applicability in society accepting data linkage projects having balanced the good against the ethical risks involved.

Conducting a Cost-Benefit Analysis of Transitional Care Programmes: The Key Challenges and Recommendations

Transitional care encompasses a range of services designed to promote care integration as patients transfer between different locations or different levels of care. Transitional care programmes have been proven to produce positive outcomes in reducing hospital readmissions and improving patients’ health outcomes. However, little is known about the benefits of the programmes on healthcare cost and the published results have been inconsistent. With increasing healthcare expenditures and limited public healthcare resources, cost-benefit analyses become paramount in informing healthcare resource allocation decisions. This perspective paper describes the approaches used in estimating the total costs of a bundle of transitional care services from an academic medical centre, identifies the key methodological challenges encountered in the process of cost-benefit analysis, and recommends potential solutions to tackle these challenges. By providing a comprehensive perspective on the methodological challenges, this paper encourages program evaluators to take these possible challenges into consideration for future cost-benefit analyses.

A novel healthcare resource allocation decision support tool: A forecasting-simulation-optimization approach

The increasing pressures on the healthcare system in the UK are well documented. The solution lies in making best use of existing resources (e.g. beds), as additional funding is not available. Increasing demand and capacity shortages are experienced across all specialties and services in hospitals. Modelling at this level of detail is a necessity, as all the services are interconnected, and cannot be assumed to be independent of each other. Our review of the literature revealed two facts; First an entire hospital model is rare, and second, use of multiple OR techniques are applied more frequently in recent years. Hybrid models which combine forecasting, simulation and optimization are becoming more popular. We developed a model that linked each and every service and specialty including A&E, and outpatient and inpatient services, with the aim of, (1) forecasting demand for all the specialties, (2) capturing all the uncertainties of patient pathway within a hospital setting using discrete event simulation, and (3) developing a linear optimization model to estimate the required bed capacity and staff needs of a mid-size hospital in England (using essential outputs from simulation). These results will bring a different perspective to key decision makers with a decision support tool for short and long term strategic planning to make rational and realistic plans, and highlight the benefits of hybrid models.