Impact Of Economic Evaluation Research Articles

Moving beyond Aim Three: a need for a transdisciplinary approach to build capacity for economic evaluations in implementation science

BackgroundUnderstanding the costs and economic benefits of implementation has been identified by policymakers and researchers as critical to increase the uptake and sustainment of evidence-based practices, but this topic remains relatively understudied. Conducting team science with health economists has been proposed as a solution to increase economic evaluation in implementation science; however, these recommendations ignore the differences in goals and perspectives in these two fields. Our recent qualitative research identified that implementation researchers predominantly approach health economists to examine costs, whereas the majority of health economists expressed limited interest in conducting economic evaluations and a desire to be more integrated within implementation science initiatives. These interviews pointed to challenges in establishing fruitful partnerships when health economists are relegated to the “Third Aim” (i.e., lowest-priority research objective) in implementation science projects by their research partners.DiscussionIn this debate paper, we argue that implementation researchers and health economists need to focus on team science research principles to expand capacity to address pressing research questions that cut across the two fields. Specifically, we use the four-phase model of transdisciplinary research to outline the goals and processes needed to build capacity in this area (Hall et al., Transl Behav Med 2:415–30, 2012). The first phase focuses on the development of transdisciplinary research teams, including identifying appropriate partners (e.g., considering policy or public health researchers in addition to health economists) and building trust. The conceptual phase focuses on strategies to consider when developing joint research questions and methodology across fields. In the implementation phase, we outline the effective processes for conducting research projects, such as team learning. Finally, in the translation phase, we highlight how a transdisciplinary approach between health economists and implementation researchers can impact real-world practice and policy.SummaryThe importance of investigating the economic impact of evidence-based practice implementation is widely recognized, but efforts have been limited due to the challenges in conducting team science across disciplines. Training in team science can help advance transdisciplinary efforts, which has the potential to increase the rigor and impact of economic evaluations in implementation science while expanding the roles taken by health economists.

Cost-effectiveness in surgery: concepts of cost-utility analysis explained.

Economic evaluations are increasingly becoming part of the surgical evidence base. With health and research guidelines emphasizing both clinical and economic benefits, surgeons will need to consider the impact of economic evaluations in the future. It seems reasonable that surgical costs in the public healthcare sector should be justified by the benefits that clinical interventions offer. Thus, it is vital to understand the methodological differences, reported outcomes and limitations of economic evaluations pertinent to surgical practice as well. As terminology and concepts can be unfamiliar to surgeons, understanding results from these studies can seem difficult. This article aims to inform surgical readers of the processes involved in performing economic evaluations to determine and compare the cost-effectiveness of treatments. The various types of economic evaluations, their uses, design characteristics, model parameters, interpretation of outputs, uncertainty analyses and notable limitations are considered. Through a hypothetical clinical example that compares costs and effects of surgical versus medical treatment for cancer, key concepts in economic evaluations are considered.

Влияние экономической оценки на выполнение работ по установлению кадастровой стоимости земель сельскохозяйственного назначения

Влияние экономической оценки на выполнение работ по установлению кадастровой стоимости земель сельскохозяйственного назначения

Economic evaluations of health technologies in Dutch healthcare decision-making: a qualitative study of the current and potential use, barriers, and facilitators

BackgroundThe use of economic evaluations in healthcare decision-making can potentially help decision-makers in allocating scarce resources as efficiently as possible. Over a decade ago, the use of such studies was found to be limited in Dutch healthcare decision-making, but their current use is unknown. Therefore, this study aimed to provide insight into the current and potential use of economic evaluations in Dutch healthcare decision-making and to identify barriers and facilitators to the use of such studies.MethodsInterviews containing semi-structured and structured questions were conducted among Dutch healthcare decision-makers. Participants were purposefully selected and special efforts were made to include decision-makers working at the macro- (national), meso- (local/regional), and micro-level (patient setting). During the interviews, a topic list was used that was based on the research questions and a literature search, and was developed in consultation with the Dutch National Healthcare Institute. Responses to the semi-structured questions were analyzed using a constant comparative approach. As for the structured questions, participants’ definitions of various economic evaluation concepts were scored as either being “correct” or “incorrect” by two researchers, and summary statistics were prepared.ResultsSixteen healthcare decision-makers were interviewed and two health economists. Decision-makers’ knowledge of economic evaluations was only modest, and their current use appeared to be limited. Nonetheless, decision-makers recognized the importance of economic evaluations and saw several opportunities for extending their use at the macro- and meso-level, but not at the micro-level. The disparity between the limited use and recognition of the importance of economic evaluations is likely due to the many barriers decision-makers experience preventing their use (e.g. lack of resources, lack of formal willingness-to-pay threshold). Possible facilitators for extending the use of economic evaluations include, amongst others, educating decision-makers and the general population about economic evaluations and presenting economic evaluation results in a clearer and more understandable way.ConclusionsThis study demonstrated that the current use and impact of economic evaluations in Dutch healthcare decision-making is limited at best. Therefore, strategies are needed to overcome the barriers that currently prevent economic evaluations from being used extensively.

Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations

In this paper we investigate to what extent perceptions of economic conditions, policy-oriented evaluations, and blame attribution affected Californians’ involvement in political activities in 2010. We use a statistical methodology that allows us to study not only the behavior of the average citizen, but also the behavior of “types” of citizens with latent predispositions that incline them toward participation or abstention. The 2010 election is an excellent case study, because it was a period when citizens were still suffering the consequences of the 2008 financial crisis and many were concerned about the state’s budgetary crisis. We find that individuals who blamed one of the parties for the problems with the budget process, and who held a position on the 2010 Affordable Care Act, were often considerably more likely to participate. We also find, however, that the impact of economic evaluations, positions on the health care reform, and blame attributions was contingent on citizens’ latent participation propensities and depended on the class of political activity.

Economic voting in Finland before and after an economic crisis

This study examines the importance of retrospective economic voting in Finland. More specifically, it investigates if the magnitude of the economic vote was greater after the global financial crisis that unfolded in 2008–2009, as well as if perceptions of the economy had an independent influence on vote choice even when controlling for long-term social cleavages and political predispositions. Using post-election survey data from the 2007 and 2011 parliamentary elections, the first empirical models suggest that the incentives to punish government parties were stronger in the aftermath of the financial crisis. The impact of economic evaluations on vote choice, however, did not remain significant when controlling for long-term anchoring forces related to social background and political predispositions.

Economic Studies Part 2: Evaluating the Quality

There are many opportunities for bias in economic evaluations. Thus, critical appraisal of economic studies is very important but complex. No standard methodology for appraisal has been universally adopted. However, consideration of the common elements that constitute a high-quality economic study provides the clinician with the tools to understand when one might be dealing with a high-quality study, a deeply flawed one, or one that made the best use of the data available. Studies of economic impact have become increasingly important in health policy decisions given the finite resources available for health care. While they should not be the sole basis of decision making, such studies provide potentially valuable information if well done. It is therefore important that high-quality economic studies be conducted and the results of economic studies be placed in the context of their quality. Learn more about economic evaluation Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programs. New York, NY: Oxford University Press; 2005 What is an economic evaluation? Introduction to Economic Evaluation. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/owcd/EET/SeriesIntroduction/1.html Health Economics Information Resources. A self-study course. National Information Center on Health Services Research and Health Care Technology (NICHSR). Available at: http://www.nlm.nih.gov/nichsr/edu/healthecon/beginningend.pdf Boos N. The impact of economic evaluation on quality management in spine surgery. Eur Spine J 2009;18(Suppl 3):338–347 Holtz A, Nelson HD, Reid E. Our questions, our decisions: standards for patient-centered outcomes research. Preliminary Draft Methodology Report; PCORI Methodology Committee; Patient-Centered Outcomes Research Institute 2012; Available at: http://www.pcori.org/assets/Preliminary-Draft-Methodology-Report.pdf Funding This article was funded by AOSpine.

The campaign dynamics of economic voting

This paper considers the relationship between election campaigns and the impact of economic evaluations on vote choice. The motivation is the standard expectation that the campaign generally serves to amplify the significance of economic considerations in the voter's calculus—to focus his/her attention on this “fundamental” element of the electoral decision. Drawing on survey data from ten national elections across four countries (Canada, New Zealand, the United Kingdom and the United States) and applying both parametric and semi-parametric statistical techniques, the paper finds no support for this proposition. The paper reflects on the significance of this conclusion for work on political learning during election campaigns, the literature on economic voting, and the study of electoral behaviour more generally.

The impact of economic evaluation on quality management in spine surgery

Health care expenditures are substantially increasing within the last two decades prompting the imperative need for economic evaluations in health care. Historically, economic evaluations in health care have been carried out by four approaches: (1) the human-capital approach (HCA), (2) cost-effectiveness analysis (CEA), (3) cost-utility analysis (CUA) and (4) cost-benefit analysis (CBA). While the HCA cannot be recommended because of methodological shortcomings, CEA and CUA have been used frequently in healthcare. In CEA, costs are measured in monetary terms and health effects are measured in a non-monetary unit, e.g. number of successfully treated patients. In an attempt to develop an effectiveness measure that incorporates effects on both quantity and quality of life, so-called Quality Adjusted Life Years (QUALYs) were introduced. Contingent valuation surveys are used in cost-benefit analyses (CBA) to elicit the consumer's monetary valuations for program benefits by applying the willingness-to-pay approach. A distinguished feature of CBA is that costs and benefits are expressed in the same units of value, i.e. money. Only recently, economic evaluations have started to explore various spinal interventions particularly the very expensive fusion operations. While most of the studies used CEA or CUA approaches, CBAs are still rare. Most studies fail to show that sophisticated spinal interventions are more cost-effective than conventional treatments. In spite of the lack of therapeutic or cost-effectiveness for most spinal surgeries, there is rapidly growing spinal implant market demonstrating market imperfection and information asymmetry. A change can only be anticipated when physicians start to focus on the improvement of health care quality as documented by outcome research and economic evaluations of cost-effectiveness and net benefits.

Men, Women and the Dynamics of Presidential Approval

Although commentary on the ‘gender gap’ is a staple of political discourse in the United States, most analyses of the dynamics of presidential approval have ignored possible gender differences in the forces driving approval ratings of US presidents. This article analyses gender differences in the impact of economic evaluations and political interventions on the dynamics of presidential approval between 1978 and 1997. The analyses are made possible by disaggregating 240 monthly Survey of Consumers datasets gathered over this period. These data show that women's economic evaluations are consistently more pessimistic than men's, regardless of who occupied the Oval Office. Analyses of rival presidential approval models reveal that a national prospective economic evaluation model performs best for women, but a personal prospective model works best for men. Parameter estimates indicate that economic evaluations accounted for substantial proportions of gender differences in presidential approval in the post-Carter era. Men and women also reacted differently to presidential transitions, with approval increasing more among men when Reagan replaced Carter, and more among women when Clinton replaced Bush. The hypothesis that men are more susceptible than women to rally effects induced by domestic and international crises and wars does not receive consistent support.

Reconciliation of Economic Concerns and Health Policy

Economic evaluations have become an important and much used tool in aiding decision makers in deciding on reimbursement or implementation of new healthcare technologies. Nevertheless, the impact of economic evaluations on reimbursement decisions has been modest; results of economic evaluations do not have a good record in predicting funding decisions. This is usually explained in terms of fairness; there is increasing awareness that valuations of QALYs may differ when the QALYs accrue to different patients. The problem, however, is that these equity concerns often remain implicit, and therefore frustrate explicitness and transparency in evidence-based decision making. It has been suggested that a so-called equity adjustment procedure may (partially) solve this problem. Typically this would involve the application of so-called equity weights, which can be used to recalculate the value of QALY gains for different patients. This paper explores such an equity adjustment procedure, using the equity concept of proportional shortfall. Proportional shortfall assumes that measurement of inequalities in health should concentrate on the fraction of QALYs that people lose relative to their remaining life expectancy, and not on the absolute number of QALYs lost or gained. It is the ratio of QALYs lost over the QALYs remaining. This equity concept combines elements of two popular but conflicting notions of equity: fair innings and severity-of-illness. We applied the concept of proportional shortfall to ten conditions and tentatively explored how an equity adjustment procedure using proportional shortfall might affect priority setting. Our equity adjustment procedure lowered the cost-effectiveness threshold when a condition was relatively mild. Because the proportional shortfall caused by the ten conditions differed considerably, the equity-adjustment procedure discriminated strongly between the ten conditions, and this experiment provided a good opportunity to explore the impact of equity adjustment for healthcare reimbursement decisions. In conclusion, our results suggest that equity can be measured and that integration of equity concerns into an economic evaluation improves the fit between economic models and reimbursement decisions. It is recommended that cost-effectiveness driven health policy systems consider equity adjustments.

The Electoral Politics of Economic Reform in Australia: The 1998 Election

Like many other advanced industrial democracies, Australia has experienced major and ongoing economic reform over the last two decades, the pace of which has, if anything, increased since the election of the Liberal‐National government in 1996. These developments have led to a growing sense of economic insecurity among many voters. Many of these concerns were focused on the 1998 election, when the Liberal‐National Coalition advocated the introduction of a goods and services tax. This paper uses the 1998 Australian Election Study (AES) survey to examine the impact of economic evaluations, economic insecurity and economic issues on voting in the election. The results demonstrate the existence of widespread economic concerns across the electorate, but that the Coalition gained a marginal electoral advantage on the tax reform issue. Economic issues were also a cause of defection to the new One Nation Party, although further analysis reveals that its support was motivated more by race and ethnic concerns than by economic discontent.

Economic evaluation of health care and policymaking

The interest in economic evaluation of health care programmes is steadily increasing, but the impact of economic evaluations on decisions concerning the allocation of resources to health care programmes is unclear. In this paper we examine different decision and policy situations where economic evaluation of health care programmes could potentially be used. Economic evaluation as an aid to: the development of treatment guidelines, decisions within health care organizations, introduction of new medical technologies, reimbursement decisions, and pricing decisions are examined. It is concluded that economic evaluation seems to be most useful in the development of treatment guidelines and as an aid to reimbursement decisions. The importance of the incentives to use economic evaluation embodied in the health care system is also stressed. It is argued that it is too early to introduce regulations that require the use of economic evaluation in for instance reimbursement decisions. A more cautious approach may be preferred with economic evaluation used more selectively until the methods and the field have developed further.

Economic evaluation of pharmaceuticals: a European perspective.

In recent years there has been a large increase in the number of economic evaluations of pharmaceuticals. Many of these studies have been commissioned by individual pharmaceutical companies, in support of new or existing products. In 2 countries, Australia and Canada (in the province of Ontario), draft guidelines issued by the government have outlined the requirements for economic evaluations to be submitted in support of requests for reimbursement (government subsidy) of particular products. One consequence of the guidelines is that they clarify what is required, and in specifying the procedure for submission of dossiers, identify a clear audience for the economic evaluation. In contrast, the situation in Europe is diverse. A wide range of healthcare systems exist, including national health services and more liberal systems, involving a wide range of insurers and providers. European countries also differ widely in their approach to the pricing and reimbursement of pharmaceuticals. Because of this diversity, the nature, conduct and impact of economic evaluation in Europe is not clear. It is therefore difficult for pharmaceutical companies to develop appropriate strategies for economic evaluation and for analysts to decide on appropriate study methodology. This article reviews the nature of any official guidance or requirements for economic evaluation, the potential for use of economic evaluation, the range of studies carried out and the identifiable impacts. There is currently no official guidance in any country, although some countries are considering issuing guidelines. In some countries there is official encouragement to pharmaceutical companies to undertake studies, and where economic data have been presented they have been considered by the relevant committees. The potential uses of economic evaluation vary widely from country to country. These can be classified in terms of a potential role in undertaking national price negotiations, deciding on reimbursement status or copayment level, deciding on inclusion in local formularies or in treatment guidelines, or in improving prescribing decisions. Approximately 80 economic evaluations of pharmaceutical products have been conducted to date in Europe, covering a wide range of clinical areas. There are relatively few examples of identifiable effects of such studies. In part this is because it is often difficult to assess the part played by various items of data. Nevertheless, the overriding conclusion is that economic evaluation of medicines is likely to be more relevant in Europe in the future. The problem for the pharmaceutical industry is in determining when and how.

Support for the Canadian Federal Progressive Conservative Party since 1988: The Impact of Economic Evaluations and Economic Issues

AbstractSince their victory in the dramatic 1988 Canadian federal election, the governing Progressive Conservatives have suffered a rapid and precipitous decline in public support. Observers have attributed the massive erosion in popularity to the failure of the Meech Lake Accord, the government's insistence on implementing the highly unpopular value-added Goods and Services Tax (GST) and increasing public reservations about the wisdom of the free trade agreement. This article contends that, while these arguments have merit, a more important factor is that many Canadians blame the federal government for the poor state of the national economy and adverse personal economic circumstances. Moreover, negative reactions to the two highly salient economic issues, free trade and the GST, are, in part at least, products of public disapproval of the government's economic performance. The analyses are based on data gathered in national cross-sectional and panel surveys conducted over the 1983–1990 period.