Special Task Force Research Articles

Regulating the Protection and Rehabilitation of Victims of Internet Child Pornography in Malaysia

Background: The conviction of Richard Huckle in London for 71 sexual offences that involved Malaysian child victims had caused uproar within the nation. 20,000 of indecent images of children, including those of which showed him committing child rape, were discovered on his computer during his arrest at Gatwick Airport in 2014. In response to this horrific event, a special task force was formed to review and propose stronger laws to protect children from sex predators. As a result, the Sexual Offences against Children Act 2017 (Act 792) was passed. Objective: This research paper seeks to evaluate the adequacy and practicality of the current Malaysian legal framework in providing a comprehensive protection for the victims of child pornography, which include issues on the viability of the penal sanctions and the access available for victims to support services. Findings are presented through library research, along with discussions with the relevant stakeholders where feasible. Conclusion: Although the laws are seemingly extensive and covered in various legislation such as the Sexual Offences against Children Act 2017, Criminal Procedure Code (Act 593), Penal Code (Act 574), and the Child Act 2001 (Act 611), it is found that there exist inconsistencies; both in terms of the definition and their purported applications that may hamper successful prosecution and effective enforcement.

The Level of Climate Change Awareness among Citizens of Bitung City, Indonesia

Knowledge about citizen’s climate change awareness level is needed to establish an appropriate policy to cope with climate change hazard, particularly in a highly vulnerable country like Indonesia. However, research regarding climate change awareness among citizens in Indonesian cities is limited. This research aims to investigate the level of climate change awareness among the citizens in Bitung City, a medium-sized city in the eastern part of Indonesia. The survey method is used in the research by analyzing questionnaires collected from the citizens. Three variables for measuring the awareness level include public concerns on climate variability, the causes of climate change, and the impacts of climate change. The findings show that the citizens of Bitung have a ”quite strong” awareness level. This contributes to the recognition of citizens’ characteristics toward climate change useful to climate change policy formulation in Indonesia, particularly the Bitung City Government. Some recommendations for the government include the incorporation of climate change issue to the citizens’ daily life and development programs by establishing a special task force of climate change at the city level.

Value-Based Pricing for Emerging Gene Therapies: The Economic Case for a Higher Cost-Effectiveness Threshold.

While one-time gene replacement therapies may offer transformative innovation for the management of ultrarare, health-catastrophic diseases, they also pose challenges to the current U.S. health care system. Historically, the United States and other countries have demonstrated a willingness to support higher prices for health gains in rare diseases. However, payers may be ill-prepared to address reimbursement based on single administrations associated with gene therapies. As yet, there is no consensus on how to appropriately reward gene therapy innovation. The purpose of this article is to characterize challenges for traditional approaches to assessing the value of one-time gene replacement therapies and to provide a health economic rationale for a higher value-based cost-effectiveness threshold (CET). There is a general recognition that ultrarare, health-catastrophic conditions should be judged against a higher CET. The Institute for Clinical and Economic Review in the United States has discussed a range of up to $500K per quality-adjusted life-year (QALY) gained for ultrarare diseases, and the National Institute for Health and Care Excellence in the United Kingdom has described a variable threshold up to £300,000 per QALY depending on the magnitude of the health gains. In practice, health technology assessment decision makers often make comparisons to "benchmarks" to justify both standard and extraordinary CETs. We briefly review and present a list of relevant benchmarks. We also sketch out how a broader concept of value could provide the basis for higher CETs for some ultrarare diseases. This approach is outlined by the recent International Society for Pharmacoeconomics and Outcomes Research Special Task Force on Value Assessment Frameworks. In addition to the QALY gains, other elements of value related to uncertainty may also be important. They include insurance value, severity of disease, real option value, value of hope, and equity. A gene therapy currently in development for the treatment of spinal muscular atrophy (SMA) provides an exemplar for discussing the issues that accompany one-time gene replacement therapies. It is imperative that we find a consensus on how to appropriately reward value created by these gene therapies to incentivize appropriate risk taking and investments by their developers-a higher CET would, by economic logic, support a higher value-based price. If consensus on appropriate rewards cannot be found for safe and effective gene therapies for diseases such as SMA with clear criticality and unmet need, it will be even more difficult to do so for diseases where the value provided is less apparent. DISCLOSURES: Funding for the writing of this article was provided by AveXis Pharmaceuticals, which reviewed the manuscript and contributed feedback during manuscript development. The authors had final editorial control. Jackson and Paul are employees of MME, a biopharmaceutical consulting firm that received funding from AveXis for work on this project. Jackson and Paul also report consulting fees from numerous other biopharmaceutical companies outside of this project. Garrison reports consulting fees from AveXis for work on this project and advisory/consultancy fees from BioMarin, Roche, Novartis, and Pfizer unrelated to this project. Kenston is a former employee of AveXis and reports consulting fees from AveXis for this project and for other projects outside of this work.

Libraries as Sustainability Leaders: ALA's Special Task Force

This article discusses the work of the American Library Association (ALA) Special Task Force on Sustainability, which identified 52 recommendations, including the adoption of sustainability as a core value of librarianship. The group aims to promote libraries as catalysts, connectors, and conveners to promote sustainability, resilience, and regeneration. The Task Force is guided by the concept of the triple bottom line, which states that an organization's practices must be not only economically feasible but also socially equitable and environmentally sound. The article also provides examples of how libraries engage in sustainable practices to support the cities and towns they serve.

Synopsis of the Oak Ridge Radiation Protection Research Needs Workshop.

Radiation protection is foundational to harnessing the societal benefits of radiation in nuclear energy, security, and medicine applications. Significant challenges in radiation protection remain unaddressed for the nuclear fuel cycle, nuclear medicine, emergency response, national defense, and space exploration, as the United States is lacking a coherent research strategy prioritizing radiation protection mission needs and gaps in scientific knowledge to meet these needs. Research and development in the field of radiation protection calls for cooperation among governmental agencies, emergency responders, research organizations, and the academic community. Amidst atrophying national expertise in radiation protection, the Radiation Protection Research Needs Workshop was spearheaded by the Oak Ridge Associated Universities, Oak Ridge National Laboratory, and the Health Physics Society. This workshop facilitated critical dialogue among radiation stakeholders in the governmental and scientific communities, including national laboratories, academic institutions, and industry partners. The workshop featured presentations representing 12 federal agencies and breakout sessions involving the identification of scientific drivers by subject matter experts in each of the following areas: new fuel cycles/reactors, dosimetry, medical physics, instrumentation and operations, decontamination and decommissioning, space radiation, national defense, emergency response, environmental modeling, and low-dose effects. The goal of this workshop was to seek stakeholder input toward the development of a national strategic research agenda in the field of radiation protection. Consequently, the Health Physics Society has established a Special Task Force on Health Physics Research Needs, tasked with the prioritization of scientific drivers in radiation protection for the development of a national strategic research agenda.

PP207 Evaluation On Effects Of Antimicrobial Stewardship In Tertiary Comprehensive Public Hospitals in Hainan, China

IntroductionThe National Health Commission issued a special task force on antimicrobial stewardship (AMS). We assess the effects of AMS from 2012 to 2016 in four tertiary comprehensive hospitals in Hainan Province, China, to explore the achievement of AMS to facilitate rational use, to control antimicrobial resistance (AMR), to ensure safety and quality of care.MethodsData from Hospital Information System (HIS) of hospitals according to the criteria of AMS were analyzed. Microsoft Excel data entry and SAS version 9.3 was used for analysis.ResultsThe indicators were general compliance to the national criteria from 2012 to 2016. The percentage of following results in hospitals were gradually reduced: the proportion of antibiotic use in outpatient care (11.09 to 3.25 percent); that in emergency departments (8.46 to 1.53 percent); antibiotics use rate of inpatient care (9.13 to 3.12 percent); antibiotics prophylactic use in type I surgical sites (24.19 to 3.38 percent); the proportion of drug cost (5.54 to 0.12 percent) and total cost of antibiotics (3.27 to 0.45 percent); total cost of antibiotics in outpatient care and emergency departments, which was below 10 percent. Pathogenic detection rate of antibiotics from 2013 to 2016 in three hospitals was increased from 38.75 to 59.6 percent. Hainan Provincial Antibiotics Resistance Monitoring Network conscientiously performs duties, several important and special detection rates of AMR close to the average national level, which have been effectively controlled.ConclusionsIt is needed to continue AMS and to enhance the capacity of rational use of antibiotics by medical professionals. Information systems need to be developed, coordinated and correlated to monitor the consumption of antibiotic use, surveillance of AMR and control of hospital infection.

Cloud Computing Adoption Strategic Planning Using ROCCA and TOGAF 9.2: A Study in Government Agency

Cloud computing is the latest paradigm that many private and public agencies have shown a significant interest in enabling the technology. However, there has been no standardize framework that support the need while aligning with business strategy. This study focuses on designing architecture framework that can help government agencies in adopting cloud solution based on ROCCA and TOGAF 9.2. Both of them are well known used for cloud adoption initiatives and architecture work, especially for organizations who are actively transforming themselves. We mapped ROCCA and TOGAF 9.2 processes to provide baseline requirements of cloud adoption. Then, validate the proposed framework with implementation and evaluation in case study for The Special Task Force of Upstream Oil and Gas Activities (SKK Migas). The result showed the processes provided are a good guidance and appropriate to support strategic government approach in analyzing and planning cloud solutions effectively.

Study on the Improve me nt of a Spe cial Fire Police Judicial Police System

최근 한국 사회의 고도성장한 경제화로 크고 작은 사건·사고가 많이 발생하면서, 안전을 갈망하는 국민의 기대로 소방분야 등 안전관련 법령이 강화되고 있지만, 법령위반 사범은 여전히 증가하는 추세이다. 이에 본 연구는 현재 일선에서 소방특별사법경찰로서 활동하고 있는 경기도·강원도 소방공무원을 중심으로 현 운영의 문제점 및 개선방 안을 설문조사하였다. 주요 연구결과로는 소방청, 광역시 ·도 소방본부 및 일선 소방서에 변호사, 전문경력관 등의 우수한 수사전문 인력을 업무에 배치·운영할 필요가 있다. 특히, 위 기관에 특사경 전담부서를 구성 및 설치하고, 소방특사경 업무의 세분화를 통해 기획수사 및 단속업무와 일선 소방서에서 처리가 곤란한 사법사건 등을 해결하여야 할 것으로 의견을 제시하였다. 또한, 향후 연구에서는 소방특사경들의 보다 전문적인 교육의 필요성과 다양한 재난 현장 경험에 관한 분야의 연구가 보완되어야할 것으로 판단된다.In recent years, the high growth of the Korean society has led to the development of large and small incidents and accidents, while safety regulations, such as the firefighting sector, have been strengthened with the expectation of people desiring safety. This study surveyed the problems and improvement plan of the current operation centered on the fire service public officers in Gyeonggi-do and Gangwon. As a result of the main research, it is necessary to arrange and carry out excellent investigative manpower, such as lawyers and professional career veterans in the fire department, metropolitan city and provincial firefighting headquarters, and frontline fire departments. In particular, it was suggested that a special task force should be established and set up in the above agency, and the planning investigation and enforcement work should be solved through subdivision of the fire special enforcement officer tasks, and the judicial cases that are difficult to be handled by the local fire station. In future research, it will be necessary to study the field of fire - fighting specialists needs for more specialized education and various disaster field experiences.

PHP286 - RESPONSES OF ISPOR MEMBERS TO THE RECOMMENDATIONS OF THE SPECIAL TASK FORCE ON US VALUE ASSESSMENT FRAMEWORKS

The concept of value based healthcare as a metaphor for assessing new therapeutic interventions has yet to identify additional metrics besides cost-effectiveness to inform public and private decision making. An ISPOR Special Task Force on Value Assessment Frameworks has recently been investigating the drivers in reimbursement decisions. Delegates at the ISPOR Europe 2017 Conference were invited to complete a questionnaire that specifically addressed current opinion on value assessment. This random survey attracted over 80 delegates from 24 countries, nearly 60% of whom considered cost-utility analysis to be a necessary component of a Value Assessment Framework. There was little agreement on whether a single transparent threshold for cost-effectiveness was appropriate, with many respondents suggesting a threshold that is much higher than the current cost/QALY. Over half (55%) of respondents considered surrogate endpoints to be acceptable for reimbursement decisions, whilst two thirds (64%) felt that MCDA might be a replacement for the QALY. Over half (53%) also felt that patients should play a more active role in health technology assessments, and risk sharing was considered to be an acceptable method of cost containment by over 70%. Finally, the majority of respondents (74%) felt it appropriate for manufacturers to command high prices for orphan drugs. In a country analysis, albeit limited by small numbers, there was general congruence between Europe and the US, apart from the need for cost-effectiveness analysis (60 vs 36% in favour, respectively). The Special Task Force has now recommended a refinement of the QALY to reflect societal values, and consider MCDA to be a viable alternative, whilst value assessment should incorporate both patient and population perspectives. The findings of this survey of ISPOR delegates were consistent with these recommendations, which illustrates the interest in the need for a Value Assessment Framework to aid reimbursement decisions.

Blockchain Technology for Detecting Falsified and Substandard Drugs in Distribution: Pharmaceutical Supply Chain Intervention.

BackgroundDrug counterfeiting is a global problem with significant risks to consumers and the general public. In the Philippines, 30% of inspected drug stores in 2003 were found with substandard/spurious/falsely-labeled/falsified/counterfeit drugs. The economic burden on the population drug expenditures and on governments is high. The Philippine Food and Drug Administration (FDA) encourages the public to check the certificates of product registration and report any instances of counterfeiting. The National Police of Philippines responds to such reports through a special task force. However, no literature on its impact on the distribution of such drugs were found. Blockchain technology is a cryptographic ledger that is allegedly immutable through repeated sequential hashing and fault-tolerant through a consensus algorithm. This project will develop and test a pharmacosurveillance blockchain system that will support information sharing along the official drug distribution network.ObjectiveThis study aims to develop a pharmacosurveillance blockchain system and test its functions in a simulated network.MethodsWe are developing a Distributed Application (DApp) that will run on smart contracts, employing Swarm as the Distributed File System (DFS). Two instances will be developed: one for Ethereum and another for Hyperledger Fabric. The proof-of-work (PoW) consensus algorithm of Ethereum will be modified into a delegated proof-of-stake (DPoS) or practical Byzantine fault tolerance (PBFT) consensus algorithm as it is scalable and fits the drug supply chain environment. The system will adopt the GS1 pedigree standard and will satisfy the data points in the data standardization guidelines from the US FDA. Simulations will use the following 5 nodes: for FDA, manufacturer, wholesaler, retailer, and the consumer portal.ResultsDevelopment is underway. The design of the system will place FDA in a supervisory data verification role, with each pedigree type–specific data source serving a primary data verification role. The supply chain process will be initiated by the manufacturer, with recursive verification for every transaction. It will allow consumers to scan a code printed on the receipt of their purchases to review the drug distribution history.ConclusionsDevelopment and testing will be conducted in a simulated network, and thus, results may differ from actual practice. The project being proposed is disruptive; once tested, the team intends to engage the Philippine FDA to discuss implementation plans and formulate policies to facilitate adoption and sustainability.Registered Report IdentifierRR1-10.2196/10163

Infografis Penguatan Reputasi Kehumasan Pemerintah melalui Narasi Tunggal Sosialisasi Paket Kebijakan Ekonomi

This study examines the role and elements of infographics for strengthening reputation of the government public relations conducted by the Special Task Force of the Government Public Relations on a single narrative related to the socialization of economic policy packages. This study uses case study method based on the perspective of the theory of reputation. The result shows that info graphics are able to make government’s message can be communicated attractively and support a reputation. It concludes (1) info graphics successfully synergize delivery of 13 single narratives about economic policy package through some form of design published in social media; (2) elements of info graphics are strengthened by the used of hashtag and logo “Indonesia Good” in the design of the content of policy packages supported by the four sides of reputation (credibility, trustworthiness, reliability, and responsibility), through the realization of a number of components to build a reputation namely core values, values, identity, projection and image. This article contributes to enrich the application model of reputation theory that generally applied to Corporate Public Relations rather than Government Rublic Relations communication.

The Attributes of Knowledge Worker as Prime Movers in Public Organizations

Civics Department in public sector of Malaysia has a major responsibility in ensuring that Malaysians instilled with the spirit of patriotism and moral values and aspirations of the nation for preparing Malaysia to achieve developed nation by 2020. With the goal to achieve its vision as a Leader of National Patriotism, a special task force known as Tenaga Penggerak (TP) has been created. This task force acts as a driver to achieve the mission by delivering excellence patriotism program through education, training, awareness and strategic partnerships. TP also have the objective to improve the knowledge and understanding of patriotism and statehood, government policies, current issues, and appreciation of moral values. TP also can be known as knowledge worker in this department based on its responsibilities and main critical success factor of every planned activities and to achieve the objective. This paper proposes positive approach to maintain the quality knowledge worker in Civics Department in instilling patriotism and statehood of Malaysian citizen.

Audiology Awareness of Undecided College Students

Audiology Awareness of Undecided College Students

Translating Evidence into Policy Change: Advocacy for Community-Based Distribution of Injectable Contraceptives in Zambia

Community-based distribution (CBD) of injectable contraceptives has increased access to family planning for millions of women in rural areas in resource-limited settings. Despite the evidence of the success of this contraceptive delivery method, many nations have yet to integrate CBD into their family planning policies. The aim of this paper to describe the process through which PATH spearheaded efforts to successfully advocate for policy change to authorize non-clinical personnel in Zambia to provide injectable contraceptives. We describe a four-part framework for policy advocacy: (a) evidence building and technical assistance, (b) stakeholder engagement, (c) government engagement, and (d) knowledge dissemination. Advocacy for policy change to allow CBD of injectable contraceptives was long and iterative. Evidence to support advocacy efforts was built through a Zambian delegates’ study tour to Rwanda to witness Rwanda’s robust CBD program and a rapid assessment of Zambian pilot sites where non-clinical personnel were administering injectable contraceptives. Advocacy was led by PATH in partnership with key stakeholders from the Zambia Family Planning Technical Working Group (FPWTG), key government officials, and a special task force of stakeholders focused on advocating for CBD of injectable contraceptives. This task force used evidence from the study tour and rapid site assessment in national and international forums to demonstrate the beneficial effects of allowing non-clinical personnel to administer injectable contraceptives. The Zambian government authorized the policy change in 2016. The policy advocacy efforts of PATH, FPWTG, and the special task force demonstrate the need for an ample evidence base and sustained engagement of government and stakeholder groups.

A Health Economics Approach to US Value Assessment Frameworks—Introduction: An ISPOR Special Task Force Report [1

Concerns about rising spending on prescription drugs and other areas of health care have led to multiple initiatives in the United States designed to measure and communicate the value of pharmaceuticals and other technologies for decision making. In this section we introduce the work of the International Society for Pharmacoeconomics and Outcomes Research Special Task Force on US Value Assessment Frameworks formed to review relevant perspectives and appropriate approaches and methods to support the definition and use of high-quality value frameworks. The Special Task Force was part of the International Society for Pharmacoeconomics and Outcomes Research Initiative on US Value Assessment Frameworks, which enlisted the expertise of leading health economists, concentrating on what the field of health economics can provide to help inform the development and use of value assessment frameworks. We focus on five value framework initiatives: the American College of Cardiology/American Heart Association, the American Society of Clinical Oncology, the Institute for Clinical and Economic Review, the Memorial Sloan Kettering Cancer Center, and the National Comprehensive Cancer Network. These entities differ in their missions, scope of activities, and methodological approaches. Because they are gaining visibility and some traction in the United States, it is essential to scrutinize whether the frameworks use approaches that are transparent as well as conceptually and methodologically sound. Our objectives were to describe the conceptual bases for value and its use in decision making, critically examine existing value frameworks, discuss the importance of sound conceptual underpinning, identify key elements of value relevant to specific decision contexts, and recommend good practice in value definition and implementation as well as areas for further research.

Review of Recent US Value Frameworks—A Health Economics Approach: An ISPOR Special Task Force Report [6

The sixth section of our Special Task Force (STF) report reviews and comments on recent US-oriented value assessment frameworks, specifically those published by the American College of Cardiology/American Heart Association, the Institute for Clinical and Economic Research, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the Memorial Sloan Kettering Cancer Center. We review published commentaries that address the validity, reliability, and conceptual underpinnings of these frameworks. We find common themes of critique regarding the strengths and limitations across frameworks. Particular shortcomings of some frameworks pose greater threats to their face validity and utility compared with others. The most significant limitations include lack of clear perspective (e.g., patient vs. health plan) and poor transparency in accounting for costs and benefits. We then review how each framework adheres to core STF recommendations, with particular emphasis on whether the framework can be used to support coverage decisions by health insurers, and whether it adheres to core principles of cost-effectiveness analysis. The Institute for Clinical and Economic Research framework most closely adheres to core STF recommendations. Others have significant limitations that vary widely from framework to framework. We also review how the frameworks follow STF recommendations for addressing potentially relevant issues beyond cost-effectiveness analysis - for example, equity in resource allocation and patient heterogeneity. Finally, we review whether and how each framework uses value thresholds and addresses affordability concerns. We conclude with suggestions for further research, particularly in the areas of testing the measurement and use of novel elements of value and deliberative processes.

An Overview of Value, Perspective, and Decision Context—A Health Economics Approach: An ISPOR Special Task Force Report [2

The second section of our Special Task Force builds on the discussion of value and perspective in the previous article of the report by 1) defining a health economics approach to the concept of value in health care systems; 2) discussing the relationship of value to perspective and decision context, that is, how recently proposed value frameworks vary by the types of decisions being made and by the stakeholders involved; 3) describing the patient perspective on value because the patient is a key stakeholder, but one also wearing the hat of a health insurance purchaser; and 4) discussing how value is relevant in the market-based US system of mixed private and public insurance, and differs from its use in single-payer systems. The five recent value frameworks that motivated this report vary in the types of decisions they intend to inform, ranging from coverage, access, and pricing decisions to those defining appropriate clinical pathways and to supporting provider-clinician shared decision making. Each of these value frameworks must be evaluated in its own decision context for its own objectives. Existing guidelines for cost-effectiveness analysis emphasize the importance of clearly specifying the perspective from which the analysis is undertaken. Relevant perspectives may include, among others, 1) the health plan enrollee, 2) the patient, 3) the health plan manager, 4) the provider, 5) the technology manufacturer, 6) the specialty society, 7) government regulators, or 8) society as a whole. A valid and informative cost-effectiveness analysis could be conducted from the perspective of any of these stakeholders, depending on the decision context.

A Health Economics Approach to US Value Assessment Frameworks—Summary and Recommendations of the ISPOR Special Task Force Report [7

This summary section first lists key points from each of the six sections of the report, followed by six key recommendations. The Special Task Force chose to take a health economics approach to the question of whether a health plan should cover and reimburse a specific technology, beginning with the view that the conventional cost-per-quality-adjusted life-year metric has both strengths as a starting point and recognized limitations. This report calls for the development of a more comprehensive economic evaluation that could include novel elements of value (e.g., insurance value and equity) as part of either an “augmented” cost-effectiveness analysis or a multicriteria decision analysis. Given an aggregation of elements to a measure of value, consistent use of a cost-effectiveness threshold can help ensure the maximization of health gain and well-being for a given budget. These decisions can benefit from the use of deliberative processes. The six recommendations are to: 1) be explicit about decision context and perspective in value assessment frameworks; 2) base health plan coverage and reimbursement decisions on an evaluation of the incremental costs and benefits of health care technologies as is provided by cost-effectiveness analysis; 3) develop value thresholds to serve as one important input to help guide coverage and reimbursement decisions; 4) manage budget constraints and affordability on the basis of cost-effectiveness principles; 5) test and consider using structured deliberative processes for health plan coverage and reimbursement decisions; and 6) explore and test novel elements of benefit to improve value measures that reflect the perspectives of both plan members and patients.

Defining Elements of Value in Health Care—A Health Economics Approach: An ISPOR Special Task Force Report [3

The third section of our Special Task Force report identifies and defines a series of elements that warrant consideration in value assessments of medical technologies. We aim to broaden the view of what constitutes value in health care and to spur new research on incorporating additional elements of value into cost-effectiveness analysis (CEA). Twelve potential elements of value are considered. Four of them—quality-adjusted life-years, net costs, productivity, and adherence-improving factors—are conventionally included or considered in value assessments. Eight others, which would be more novel in economic assessments, are defined and discussed: reduction in uncertainty, fear of contagion, insurance value, severity of disease, value of hope, real option value, equity, and scientific spillovers. Most of these are theoretically well understood and available for inclusion in value assessments. The two exceptions are equity and scientific spillover effects, which require more theoretical development and consensus. A number of regulatory authorities around the globe have shown interest in some of these novel elements. Augmenting CEA to consider these additional elements would result in a more comprehensive CEA in line with the “impact inventory” of the Second Panel on Cost-Effectiveness in Health and Medicine. Possible approaches for valuation and inclusion of these elements include integrating them as part of a net monetary benefit calculation, including elements as attributes in health state descriptions, or using them as criteria in a multicriteria decision analysis. Further research is needed on how best to measure and include them in decision making.

Objectives, Budgets, Thresholds, and Opportunity Costs—A Health Economics Approach: An ISPOR Special Task Force Report [4

The fourth section of our Special Task Force report focuses on a health plan or payer’s technology adoption or reimbursement decision, given the array of technologies, on the basis of their different values and costs. We discuss the role of budgets, thresholds, opportunity costs, and affordability in making decisions. First, we discuss the use of budgets and thresholds in private and public health plans, their interdependence, and connection to opportunity cost. Essentially, each payer should adopt a decision rule about what is good value for money given their budget; consistent use of a cost-per-quality-adjusted life-year threshold will ensure the maximum health gain for the budget. In the United States, different public and private insurance programs could use different thresholds, reflecting the differing generosity of their budgets and implying different levels of access to technologies. In addition, different insurance plans could consider different additional elements to the quality-adjusted life-year metric discussed elsewhere in our Special Task Force report. We then define affordability and discuss approaches to deal with it, including consideration of disinvestment and related adjustment costs, the impact of delaying new technologies, and comparative cost effectiveness of technologies. Over time, the availability of new technologies may increase the amount that populations want to spend on health care. We then discuss potential modifiers to thresholds, including uncertainty about the evidence used in the decision-making process. This article concludes by discussing the application of these concepts in the context of the pluralistic US health care system, as well as the “excess burden” of tax-financed public programs versus private programs.