Collaborations for Leadership In Applied Health Research and Care East of England Health Economics Adam Wagner 14/03/2019
What is the work of health economists ? • Addressing infinite health demand with scarce resources: • Efficient resource allocation • Maximise value for money • Varied work! • Economic evaluations • Outcome valuation • Providing evidence for policy Health Economics Theme
Health Economic (HE) Theme • Non-exclusive focus on economic evaluation (EE) • Cross cutting theme: • Methodological work: • Resource data collection in care homes • Replicating decision models • Work with other themes: • Mindful student study – EE • EQUIP trial – EE feasibility • CASCADE – HE information Health Economics Theme
Background: Economic evaluation • Comparing the costs AND benefits of two or more treatment alternatives • Requires: • Collection of resource use → costs • Benefits → Often measured in quality adjusted life years (QALYs) • Looking for cost-effectiveness Health Economics Theme
Health Economic (HE) Theme • Non-exclusive focus on economic evaluation • Cross cutting theme: • Methodological work: • Resource data collection in care homes • Replicating decision models • Work with other themes: • Mindful student study – EE • EQUIP trial – feasibility of EE • CASCADE – HE information Health Economics Theme
Resource use collection within care home settings (Tracey Sach) • Resource use → costs • Limited research on methods • None in care home setting • In CAREMED trial (multi-professional clinical medication reviews in care homes), a pharmacy tech recorded every visit or contact in: • GP electronic records • Care home paper records Health Economics Theme
Resource use collection within care home settings: Comparison+Impacts • Significantly different overall mean Data Care source GP home contacts (95% CI: 2.1, 5.0) & costs (CI: 74, 206) Mean overall 12.5 16.0 contacts → Impact on conclusions! Mean overall cost £625 £765 Mean GP visits 7.1 5.8 • Very limited agreement: Mean GP costs £306 £251 • Biggest dif.: district nurse • Mean district Care home more complete? 3.1 6.3 nurse visits • Most impactful resources: GP; Mean district £130 £262 district nurses; nurse costs specialist nurse Health Economics Theme
Health Economic (HE) Theme • Non-exclusive focus on economic evaluation • Cross cutting theme: • Methodological work: • Resource data collection in care homes • Replicating decision models • Work with other themes: • Mindful student study – EE • EQUIP trial – feasibility of EE • CASCADE – HE information Health Economics Theme
Replicability of decision models: Background • Scientific principle: Replicability • Decision models: key EE tool Dean et al. (2001) • Rarely replicate models; • Not thought practical at ISPOR • Importance: • Models inform funding • Greater model clarity → promotes understanding • Defend against manipulation • Check for errors! Health Economics Theme
Replicability of decision models: Method & results • 5 models from literature in different clinical conditions • 5 different modellers (of varying experience) try to replicate each model & related results • Difficult! • See McManus et al.! (under review) • Health Economics Theme
Health Economic (HE) Theme • Non-exclusive focus on economic evaluation (EE) • Cross cutting theme: • Methodological work: • Resource data collection in care homes • Replicating decision models • Work with other themes: • Mindful student study – EE • EQUIP trial – EE feasibility • CASCADE – HE information Health Economics Theme
Mindful student study (Julieta Galante & Peter Jones) • 2 arm trial investigating if mindfulness increases resilience among university students • It does! Galante et al. (2017) • Economic evaluation: How do the additional costs and benefits to the university counselling service of delivering mindfulness (mental health scores/QALYs) compare to current services? <analysis underway> Health Economics Theme
Health Economic (HE) Theme • Non-exclusive focus on economic evaluation (EE) • Cross cutting theme: • Methodological work: • Resource data collection in care homes • Replicating decision models • Working with other themes: • Mindful student study – EE • EQUIP trial – EE feasibility • CASCADE – HE information Health Economics Theme
EQUIP Feasibility trial (Economics): Garry Barton • Adults with intellectual developmental disabilities (IDD) detained in secure units & history of criminal behaviour • Economic evaluation feasibility: • Resource use collectable? • Quality of life (EQ-5D) collectable? • Analysis: • Completion rates • Identify large cost drivers • Prelimin. cost effectiveness Health Economics Theme
Health Economic (HE) Theme • Non-exclusive focus on economic evaluation (EE) • Cross cutting theme: • Methodological work: • Resource data collection in care homes • Replicating decision models • Work with other themes: • Mindful student study – EE • EQUIP trial – EE feasibility • CASCADE – HE info Health Economics Theme
CASCADE – dementia case finding (Frances Bunn) • Dementia case finding: memory assessment of 75+ admitted unexpectedly • Delivery approach? Impact? • HE explored: • Costs of case finding • Quality of life of identified cases • Impact on services Health Economics Theme
Health economics: Going forward • Evidence to inform implementation decisions • Application and extension of measurement & valuation methods • Economic evaluation • ‘Holistic’ benefits: patient -centred outcomes • Social AND health outcomes • Public prioritisation preferences for health and social care Health Economics Theme
Questions? adam.wagner@uea.ac.uk HE theme: Garry Barton, Christina-Jane Crossman-Barnes Lisa Irvine, David Turner, Emma McManus, Tracey Sach, Angela Robinson, Chris Skedgel, Adam Wagner, Jenny Whitty McManus, E., Turner, D., Gray, E., Khawar, H., Okoli, T., Sach. T. (under review). The Barriers and Facilitators to Model Replication within Health Economics. Sach, T., Desborough, J., Houghton, J. & Holland, R. (2018). “A comparison of two sources of primary and social care resource use data in a care home setting” In Unit Costs of Health and Social Care 2018, edited by Curtis, L. & Burns, A. Kent, Canterbury: PSSRU, University of Kent. https://www.pssru.ac.uk/pub/uc/uc2018/sach.pdf Health Economics Theme
Recommend
More recommend
