Inappropriate Resource Research Articles

Curative Care Utilization under Family Medicine and Rural Insurance in Amol – Iran

Background and purpose: Reliable information about utilization of medical services is key for making appropriate decisions of all healthcare systems. Nonetheless, most policy decisions and planning in the rural areas of developing countries are made with the lack of such crucial information. In this article we attempt to reveal the pattern of curative care utilization of rural population in Amol, a county in Northern Province of Mazandaran. Methods: In this study 355 patients living in rural area who in the last three month utilized curative care from different providers were interviewed in their doorsteps. All interviewees were heads of family or people age above 15. SPSS software was used for analyzing the data. Results: About a quarter of patients (24.5%) have referred to their local family physicians. It is noticeable that the proportion of people who referred to GP out of family physicians scheme exceeds the proportion of patients referred to GPs who are working as family physicians in the FMRI scheme. Among the studied variables, only basic insurance, severity of disease, and type of care utilized had significant association with referred or not referred of individuals to their own family physicians.Conclusion:Family medicine and rural insurance in Iran has increased the overall service utilization of population in rural areas but not in the scale that the government has spent its limited healthcare resources. This raises the concern of inappropriate resource allocation for inappropriate people and inappropriate services.

Triage for low income countries: is ESI truly the way forward?

A triage desk at the doorstep of an emergency department (ED) is to “sort, select or prioritize” presenting patients as per their clinical needs. Many triage systems exist globally, however, the need and/or practical applicability of any triage is dictated by the hospital system and setting. In low-income/developing countries, the triage system must be capable and proficient enough to pair the right patient with the most appropriate management. Ineffective and/or in-efficient triage leads to overcrowding, delays, inappropriate resource utilization and patient dissatisfaction. A sizeable proportion of triage systems rely on three to five levels/tiers. Five level triage systems, such as the Australian Triage System (ATS) and the Canadian Triage Acuity Scale (CTAS), to name a few, are widely used worldwide. Based on door-to-physician time, these systems not only allow the institution to monitor and meet the timelines recommended by the institution policies, but have also been identified as an effective triage tool hence widely adopted in hospitals of developed countries. However, both ATS and CTAS are time-consuming and require skilled and qualified nursing staff to process it. On the other hand, the ESI (Emergency Severity Index) scale which is also a 5-level triage system, categorizes patients based on resource requirement and severity of the patient’s condition. Although ESI is in the developing phase, it is proving to be nurse-friendly and reliable in both intra and inter-rated conditions. The aim of this paper is to critically analyze the merits and pitfalls of the ESI system, in addition to proposing further modifications, in order to fulfill the needs of a developing country.

Dynamic workload patterns prediction for proactive auto-scaling of web applications

Proactive auto-scaling methods dynamically manage the resources for an application according to the current and future load predictions to preserve the desired performance at a reduced cost. However, auto-scaling web applications remain challenging mainly due to dynamic workload intensity and characteristics which are difficult to predict. Most existing methods mainly predict the request arrival rate which only partially captures the workload characteristics and the changing system dynamics that influence the resource needs. This may lead to inappropriate resource provisioning decisions. In this paper, we address these challenges by proposing a framework for prediction of dynamic workload patterns as follows. First, we use an unsupervised learning method to analyze the web application access logs to discover URI (Uniform Resource Identifier) space partitions based on the response time and the document size features. Then for each application URI, we compute its distribution across these partitions based on historical access logs to accurately capture the workload characteristics compared to just representing the workload using the request arrival rate. These URI distributions are then used to compute the Probabilistic Workload Pattern (PWP), which is a probability vector describing the overall distribution of incoming requests across URI partitions. Finally, the identified workload patterns for a specific number of last time intervals are used to predict the workload pattern of the next interval. The latter is used for future resource demand prediction and proactive auto-scaling to dynamically control the provisioning of resources. The framework is implemented and experimentally evaluated using historical access logs of three real web applications, each with increasing, decreasing, periodic, and randomly varying arrival rate behaviors. Results show that the proposed solution yields significantly more accurate predictions of workload patterns and resource demands of web applications compared to existing approaches.

Anthropogenic Drying of Lakes in Arid and Semi-Arid Regions

Soils and forests are deteriorating; grazing lands are degraded; water points, sources, and lakes are drying, and underground water levels diminished. This could largely be attributed to traditional inappropriate resource management methods; severe soil erosion and degradations reducing infiltration and resulting in sedimentation of water sources and lake basins. Bad cultivation practices, burning and cutting of perennial vegetation, overgrazing and grass fires increase runoff. This causes soil erosion and consequently sediment transport to the lake, which results in the decrease of its storage capacity and quality of stored water. Shallow and groundwater dependent Lakes has experiencing shrinkage and some of them are vanished due to different reasons, such as human activities, climate change and related which can contribute to the declining of Lake Ecosystem.

Microfinance for poverty alleviation: Do transnational initiatives overlook fundamental questions of competition and intermediation?

Numerous microfinance initiatives around the world aim to alleviate poverty in developing countries. However, debate persists about their effectiveness and sustainability – a concern for transnational corporations and the international business community, which contribute about $9.4 billion to microfinance funding. In this policy-oriented article we aggregate findings from two studies in Indonesia that help explain why moneylending can still thrive when low-interest microfinance is widely available and why the poorest borrowers benefit less than the less-poor. To avoid methodological debates about validity, we interview market participants and triangulate the perspectives of borrowers with those of formal and informal lenders. Importantly, our research includes current and past borrowing from formal and informal sources, prompting participants to draw comparisons. We find that the importance to borrowers of key characteristics of informal lending is insufficiently recognized and that inappropriate human resource management and informal intermediation are significant problems. The latter can be an unintended consequence of formal microfinance: The availability of formal low-interest microfinance creates informal intermediation opportunities for entrepreneurs, often developing from casual intermediation into systematic deception. We discuss implications for microfinance policy with reference to the United Nations Sustainable Development Goals and offer suggestions for further research.

State-taint analysis for detecting resource bugs

To ensure that a program uses its resources in an appropriate manner is vital for program correctness. A number of solutions have been proposed to check that programs meet such a property on resource usage. But many of them are sophisticated to use for resource bug detection in practice and do not take into account the expectation that a resource should be used once it is opened or required. This open-but-not-used problem can cause resource starvation in some cases, for example, smartphones or other mobile devices where resources are not only scarce but also energy-hungry, hence inappropriate resource usage can not only cause the system to run out of resources but also lead to much shorter battery life between battery recharge. That is the so-call energy leak problem. In this paper, we propose a static analysis called state-taint analysis to detect resource bugs. Taking the open-but-not-used problem into account, we specify the appropriate usage of resources in terms of resource protocols. We then propose a taint-like analysis which employs resource protocols to guide resource bug detection. As an extension and an application, we enrich the protocols with the inappropriate behaviours that may cause energy leaks, and use the refined protocols to guide the analysis for energy leak detection. We implement the analysis as a prototype tool called statedroid . Using this tool, we conduct experiments on several real Android applications and test datasets from Relda and GreenDroid. The experimental results show that our tool is precise, helpful and suitable in practice, and can detect more energy leak patterns. • An analysis to detect resource bugs guided by resource protocols is proposed. • The analysis is extended to analyse special program bugs like energy leaks. • A tool for detecting energy leaks for Android applications is implemented. • A series of experiments are conducted to evaluate the analysis.

RESOURCE MAINTENANCE TREATMENT OF ARTERIAL HYPERTENSION IN OUTPATIENT CLINICS

Due to the significant financial costs associated with the management of arterial hypertension (HTN), the optimization of health care resource distribution is required. Objective. To study the resource maintenance treatment of HTN in outpatient clinics. design and methods. The study included two stages. Firstly, we selected a sample of primary HTN patients based on the screening of primary medical records (n = 1766). Secondly, we performed a telephone survey 6 months after the inclusion (n = 1419). Results. Outpatients are characterized by a high frequency of visits to the doctor: 2,9 physician’s counseling, 2,6 cardiologist’s counseling, 0.21 cases of medical emergencies, 0.08 hospitalizations per 1 patient for 6 months on average. Significant use of health care resources was found in the following groups: patients aged 60 years and older, who periodically or regularly measure blood pressure (BP), regularly take antihypertensive therapy (AHT), those who have drug incentives, do not use fixed combinations, with uncontrolled BP, coronary heart disease (СHD), who take 3 or more antihypertensive drugs, who changed or withdrew the recommended AHT. Although achieving target BP is associated with a reduced likelihood of medical emergency calls and outpatient physician’s counseling, there was not difference in the number of hospitalizations between the groups with achieved target BP and the group with uncontrolled HTN. Total direct costs for 6 months composed 9 283,13 rubles per one study participant. Factors associated with a higher total direct costs included age 60 years or older, a high level of self-monitoring of BP, regular intake of AHT, the opportunity of drug incentives, the presence of СHD, uncontrolled HTN, multiple combination antihypertensive therapy (3 drugs and more), no use of fixed combinations, changes or withdrawal of recommended AHT. Conclusions. Our analysis of resource provision and cost-effectiveness of HTN treatment allowed to identify the groups of patients with inappropriate resource expenses. These data demonstrate the need for targeted interventions in order to reduce the economic burden of HTN.

Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records

IntroductionThe appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. MethodsMedical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients’ medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. ResultsInappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards’ specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients’ higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. ConclusionsSome individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate inexpensive real-time data for identifying what determines potentially inappropriate hospital resource usage, and thus orient auditing activities and health care policy-making.

The diagnostic yield of CTPA: pulmonary embolism, alternative diagnoses and incidental findings

Aims: In this retrospective study we assess the diagnostic yield of computed tomography pulmonary angiogram (CTPA) and the incidence of alterative and incidental diagnoses. Methods: The results of all CTPA scans performed in our trust over a period of 18 months were reviewed and all diagnoses noted. Data collected was descriptively analysed. Results: A total of 1138 scans were performed (56.5% men, mean age 59 years). A diagnosis of pulmonary embolism (PE) was made in 20.2%, an alternative aetiology for presenting symptoms in 26.4% and incidental findings in 19.5%. The commonest alternative diagnosis was pneumonia (9.5%). Conclusions: Significant numbers of CTPA yield unexpected findings, which may provide an explanation for the clinical presentation. Furthermore substantial numbers of incidental pathologies are also diagnosed which may lead to inappropriate resource utilization and increased patient anxiety.

World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease.

PROBIOTICS—THE CONCEPTHistory and DefinitionsA century ago, Elie Metchnikoff (a Russian scientist, Nobel laureate, and professor at the Pasteur Institute in Paris) postulated that lactic acid bacteria (LAB) offered health benefits capable of promoting longevity. He suggested that “intestinal autoint

A fast and resource efficient mining algorithm for discovering frequent patterns in distributed computing environments

The advancement of electronic technology enables us to collect logs from various devices. Such logs require detailed analysis in order to be broadly useful. Data mining is a technique that has been widely used to extract hidden information from such data. Data mining is mainly composed of association rules mining, sequent pattern mining, classification and clustering. Association rules mining has attracted significant attention and been successfully applied to various fields. Although the past studies can effectively discover frequent patterns to deduce association rules, execution efficiency is still a critical problem. To speed up execution, many methods using parallel and distributed computing technology have been proposed in recent years. Most of the past studies focused on parallelizing the workload in a high end machine or in distributed computing environments like grid or cloud computing systems; however, very few of them discuss how to efficiently determine the appropriate number of computing nodes, considering execution efficiency and load balancing. An intuition is that execution speed is proportional to the number of computing nodes—that is, more the number of computing nodes, faster is the execution speed. However, this is incorrect for such algorithms because of the inherently algorithmic design. Allocating too many computing nodes can lead to high execution time. In addition to the execution inefficiency, inappropriate resource allocation is a waste of computing power and network bandwidth. At the same time, load cannot be effectively distributed if there are too few nodes allocated. In this paper, we propose a fast, load balancing and resource efficient algorithm named FLR-Mining for discovering frequent patterns in distributed computing systems. FLR-Mining is capable of determining the appropriate number of computing nodes automatically and achieving better load balancing as compared with existing methods. Through empirical evaluation, FLR-Mining is shown to deliver excellent performance in terms of execution efficiency and load balancing.

Abstract W MP118: Influence of Do-Not-Resuscitate Orders on Length of Stay and Cost of care after Intracerebral Hemorrhage after Charlson's Comorbidity Index adjustment in United States

Background: The trends in utilization of Do-Not-Resuscitate Orders (DNR) and its effect upon outcomes among patients with intracerebral hemorrhage (ICH) is not studied within a national representative population. Objective: To identify the contemporary rate of utilization impact of DNR status on length of stay (LOS) and cost of care among patients (pts) admitted with ICH. Methods: We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2011 for ICH using ICD 9-CM code (431) as a primary diagnosis. We defined patients’ DNR status with ICD CM code - V49.86 as a secondary diagnosis. Comorbid conditions were defined by Charlson's Comorbidity Index (CCI). Cost to charge ratio files were merged with NIS to calculate cost of care. LOS was calculated only in pts who were alive. T test was utilized for univariate analysis for continuous variable. Hierarchical multilevel regression models were generated to determine independent predictors of LOS and cost of care. Results: Total of 13440 pts (weighted: 64617) with ICH were analyzed, out of which 2029 pts (weighted: 9713) had DNR orders. Average LOS and cost of care for all ICH pts were 8.76 ± 0.12 days and $ 19386 ± 261, respectively. In univariate analysis, LOS and cost of care were lower in DNR pts (LOS: 5.76 ± 0.34 vs. 9.04± 0.13, p <0.001; Cost: $11020 ± 400 vs. $20916 ± 298, P <0.001). In multivariate analysis, the results were (days/cost, 95% CI, P-value) (LOS: -1.30 days, -2.26 - -0.35, p<0.001; cost: $ -5509, -6851 - -4168, p<0.001). Elective admission was associated with decrease in cost (Cost: $ -2439, -4506 - -372, p=0.02). Pts with private insurance were more likely to have decrease LOS and cost of care (LOS: -1.62, -2.35 - -0.90, p<0.001; Cost: -1439, -2745 - -132, p=0.03) as compared with Medicare/Medicaid. Hospital teaching status was associated increase in cost of care while self pay/others was associated with decrease in cost of care. CCI >= 3 was associated with increase in both cost of care and LOS as compared to CCI= 1. Conclusions: DNR status in patient with ICH is a predictor of a significantly lower LOS and cost of care. Appropriate use of DNR status may reduce LOS and cost of care in ICH patients and decrease inappropriate resource utilization.

How the environment determines banking efficiency: a comparison of banking firms in Taiwan, Hong Kong, and Mainland China

This study uses the three-stage data envelopment analysis (DEA) model to explore the true managerial efficiency of the banking firms in Taiwan, Hong Kong, and Mainland China. The empirical results indicate that the environmental conditions have a significant impact on banking efficiency. When the country-specific situations are important factors in explaining efficiency difference, the common frontier estimates obtained by neglecting those factors can generate biased and overestimated inefficiency levels. With findings obtained from the slack variable analyses, the current study can provide inefficient banks with ways to reduce their input waste through the adjustment of input allocations. The findings also confirm the importance of the three-stage DEA and its applications in determining the true managerial efficiencies of banks. Without the three-stage DEA, the management could be misguided when making strategic decisions and conducting inappropriate resource allocation.

Human Resource Allocation Model in Pavement Engineering

Human resource allocation holds the key to success in the construction of labor-intensive public infrastructures. However, due to the difficulty in obtaining relevant onsite data, there has been a lack of quantitative numerical analysis and discussion in published literature. In this study, a database for assessing human resource allocation in pavement engineering was established by collecting detailed information from various construction projects. Fourteen influence factors were summarized through literature review and consultation with experts in the field. Thirty two road-smoothing projects were then randomly selected. Using the rough set approach and an artificial neural network model, a model for assessing human resource allocation in pavement engineering was developed. The model validity is verified by an average accuracy of 88.63%. Therefore, this proposed model can be viewed as a useful tool for estimating human resource demand in pavement engineering. It can also effectively alert the authority to avoid a shortage in manpower, preventing the construction project from falling behind schedule or even early termination as a result of inappropriate resource allocation.

Radiology Services Costs and Utilization Patterns Estimates in Southeastern Europe—A Retrospective Analysis from Serbia

ObjectiveAssessment of costs matrix and patterns of prescribing of radiology diagnostic, radiation therapy, nuclear medicine, and interventional radiology services. Another aim of the study was insight into drivers of inappropriate resource allocation. MethodsAn in-depth, retrospective bottom-up trend analysis of services consumption patterns and expenses was conducted from the perspective of third-party payer, for 205,576 inpatients of a large tertiary care university hospital in Serbia (1,293 beds) from 2007 to 2010. ResultsA total of 20,117 patients in 2007, 17,436 in 2008, 19,996 in 2009, and 17,579 in 2010 were radiologically examined, who consumed services valued at €2,713,573.99 in 2007, €4,529,387.36 in 2008, €5,388,585.15 in –2009, and €5,556,341.35 in 2010. ConclusionsThe macroeconomic crisis worldwide and consecutive health policy measures caused a drop in health care services diversity offered in some areas in the period 2008 to 2009. In spite of this, in total it increased during the time span observed. The total cost of services increased because of a rise in overall consumption and population morbidity. An average radiologically examined patient got one frontal chest graph, each 7th patient got an abdomen ultrasound examination, each 19th patient got a computed tomography endocranium check, and each 25th patient got a head nuclear magnetic resonance. Findings confirm irrational prescribing of diagnostic procedures and necessities of cutting costs. The consumption patterns noticed should provide an important momentum for policymakers to intervene and ensure higher adherence to guidelines by clinicians.

PP051. Budget impact analysis of maternal plasma PIGF concentrations in women with suspected pre-eclampsia: The potential for improved health service usage

Existing methods of assessing women with suspected pre-eclampsia are expensive and labour intensive, yet perform poorly. The PELICAN multi-centre observational cohort study demonstrated that PlGF predicts need for delivery for pre-eclampsia within 14 days. We constructed a decision analytical model using outcome data from 100 women comparing resource use by final diagnosis and PlGF level. Costs were obtained from 2012-2013 NHS tariffs. Of the 100 women, 40 had a final diagnosis of pre-eclampsia and delivered within 14 days of the PlGF test; 10 were healthy pregnancies with normal PlGF levels. 82% of women with pre-eclampsia were admitted during the final 2 weeks of pregnancy, with a 5-day (SD=5) length of stay, compared with 30% of healthy pregnancies with normal PlGF (1 day; SD=0.58). Resource use for outpatient appointments, scans and day unit admissions was similar for the two groups although higher in the group with a final diagnosis of pre-eclampsia. Total costs, excluding delivery, were approximately a third higher in the pre-eclampsia group. This interim analysis suggests pre-eclampsia is associated with significantly higher resource use, although there is some inappropriate resource use in healthy women. PlGF can assist diagnosis and identify women requiring increased care and could be used to direct appropriate resource allocation in women over 37 weeks.

A proposal for interdisciplinary, nurse-coordinated atrial fibrillation expert programmes as a way to structure daily practice

Atrial fibrillation (AF) is a frequently occurring arrhythmia that is independently related to increased morbidity and mortality. In particular, AF is associated with complications such as ischaemic stroke, systemic thrombo-embolism, and heart failure, leading to increased hospitalizations.1 Atrial fibrillation, therefore, has a major impact on healthcare systems, which is likely to expand in an ageing population.1–3 Although AF can occur asymptomatically, two-thirds of the patients experience symptoms. The management of AF is, besides stroke prevention, predominantly focused on controlling symptoms and on improving quality of life (QOL).1,2,4 Symptom profile and burden can vary over time, both within and between patients. Consistent symptom assessment and follow-up are therefore important. Moreover, evidence-based guidelines facilitate clinicians in obtaining positive patient outcomes.1,2,5,6 Nonetheless, guideline adherence in practice is often poor,7 leading to suboptimal symptomatic control, reduced benefit from proven treatments on morbidity and mortality, and inappropriate healthcare resource use. Recognizing that symptom management and improving guideline adherence are important both for patients individually and for the impact on healthcare systems globally, it is mandatory to develop and implement more efficient ways to deal with AF.6,8,9 However, the best model for implementing AF care is still unclear. This article presents our viewpoint regarding optimized AF management by comprehensively addressing (i) the main goals to be achieved; (ii) the related requirements for AF management programmes to achieve those goals; (iii) our position that nurses should have an important coordinating role in such programmes; (iv) the implementation of such programme in practice; and (v) which outcomes should be targeted to evaluate effective deployment. Atrial fibrillation care should be organized to achieve clearly defined outcomes.10 As AF management is aimed at reducing symptoms and preventing …

Five Things Physicians and Patients Should Question in Hospice and Palliative Medicine

Overuse or misuse of tests and treatments exposes patients to potential harm. The American Board of Internal Medicine Foundation's Choosing Wisely® campaign is a multiyear effort to encourage physician leadership in reducing harmful or inappropriate resource utilization. Via the campaign, medical societies are asked to identify five tests or procedures commonly used in their field, the routine use of which in specific clinical scenarios should be questioned by both physicians and patients based on the evidence that the test or procedure is ineffective or even harmful. The American Academy of Hospice and Palliative Medicine (AAHPM) was invited, and it agreed to participate in the campaign. The AAHPM Choosing Wisely Task Force, with input from the AAHPM membership, developed the following five recommendations: 1) Don't recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral-assisted feeding; 2) Don't delay palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease-directed treatment; 3) Don't leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care; 4) Don't recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis; and 5) Don't use topical lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®) (ABH) gel for nausea. These recommendations and their supporting rationale should be considered by physicians, patients, and their caregivers as they collaborate in choosing those treatments that do the most good and avoid the most harm for those living with serious illness.

A Mode Shifting Resource Allocation Scheme for Device-to-Device Underlaying Cellular Network

Device-to-Device (D2D) communication underlaying a cellular network is a promising technique, and it has recently been proposed for booming local services, which will greatly improve system capacity by sharing the same resource blocks of cellular users at the same time. However, the mutual interference brought by inappropriate resource reuse will deteriorate the performance of the whole system. In this paper, a mode shifting resource allocation scheme is presented without channel state information (CSI) of D2D link and D2D user to cellular user link. D2D pair traditionally shares resource block of cellular user with the best channel to reduce the relative interference to cellular link. While in the other way, for the same purpose, the D2D user can also reuse the resource block over which its transmitter has the worst channel between itself and base station (BS), in addition a simple strategy is put up to select the reusing mode that provides larger capacity. Numerical results show that our proposed scheme performs significantly better than reference scheme in terms of system capacity and outage probability of cellular link, besides the scheme will not cause any extra complexity.

SOCIETAL VIEWS ON NICE, CANCER DRUGS FUND AND VALUE‐BASED PRICING CRITERIA FOR PRIORITISING MEDICINES: A CROSS‐SECTIONAL SURVEY OF 4118 ADULTS IN GREAT BRITAIN

The criteria used by the National Institute for Health and Clinical Excellence (NICE) for accepting higher incremental cost-effectiveness ratios for some medicines over others, and the recent introduction of the Cancer Drugs Fund (CDF) in England, are assumed to reflect societal preferences for National Health Service resource allocation. Robust empirical evidence to this effect is lacking. To explore societal preferences for these and other criteria, including those proposed for rewarding new medicines under the future value-based pricing (VBP) system, we conducted a choice-based experiment in 4118 UK adults via web-based surveys. Preferences were determined by asking respondents to allocate fixed funds between different patient and disease types reflecting nine specific prioritisation criteria. Respondents supported the criteria proposed under the VBP system (for severe diseases, address unmet needs, are innovative--provided they offered substantial health benefits, and have wider societal benefits) but did not support the end-of-life premium or the prioritisation of children or disadvantaged populations as specified by NICE, nor the special funding status for treatments of rare diseases, nor the CDF. Policies introduced on the basis of perceived--and not actual--societal values may lead to inappropriate resource allocation decisions with the potential for significant population health and economic consequences.