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Klumpp M, Loske D, Bicciato S. COVID-19 health policy evaluation: integrating health and economic perspectives with a data envelopment analysis approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1263-1285. [PMID: 35015167 PMCID: PMC8748527 DOI: 10.1007/s10198-021-01425-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/21/2021] [Indexed: 05/05/2023]
Abstract
The COVID-19 pandemic is a global challenge to humankind. To improve the knowledge regarding relevant, efficient and effective COVID-19 measures in health policy, this paper applies a multi-criteria evaluation approach with population, health care, and economic datasets from 19 countries within the OECD. The comparative investigation was based on a Data Envelopment Analysis approach as an efficiency measurement method. Results indicate that on the one hand, factors like population size, population density, and country development stage, did not play a major role in successful pandemic management. On the other hand, pre-pandemic healthcare system policies were decisive. Healthcare systems with a primary care orientation and a high proportion of primary care doctors compared to specialists were found to be more efficient than systems with a medium level of resources that were partly financed through public funding and characterized by a high level of access regulation. Roughly two weeks after the introduction of ad hoc measures, e.g., lockdowns and quarantine policies, we did not observe a direct impact on country-level healthcare efficiency, while delayed lockdowns led to significantly lower efficiency levels during the first COVID-19 wave in 2020. From an economic perspective, strategies without general lockdowns were identified as a more efficient strategy than the full lockdown strategy. Additionally, governmental support of short-term work is promising. Improving the efficiency of COVID-19 countermeasures is crucial in saving as many lives as possible with limited resources.
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Affiliation(s)
- Matthias Klumpp
- Chair of Production and Logistics Management, Department for Business Administration, Georg-August-University of Göttingen, Platz der Göttinger Sieben 3, 37073, Göttingen, Germany.
- FOM University of Applied Sciences Essen, Leimkugelstr. 6, 45141, Essen, Germany.
- Fraunhofer Institute for Material Flow and Logistics IML Dortmund, J.-v.-Fraunhofer-Str. 2-4, 44227, Dortmund, Germany.
| | - Dominic Loske
- Chair of Production and Logistics Management, Department for Business Administration, Georg-August-University of Göttingen, Platz der Göttinger Sieben 3, 37073, Göttingen, Germany
- FOM University of Applied Sciences Essen, Leimkugelstr. 6, 45141, Essen, Germany
| | - Silvio Bicciato
- Interdepartmental Center for Stem Cells and Regenerative Medicine (CIDSTEM), Department of Life Sciences, University of Modena and Reggio Emilia, Via Gottardi 100, 41125, Modena, Italy
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Colson AR, Morton A, Årdal C, Chalkidou K, Davies SC, Garrison LP, Jit M, Laxminarayan R, Megiddo I, Morel C, Nonvignon J, Outterson K, Rex JH, Sarker AR, Sculpher M, Woods B, Xiao Y. Antimicrobial Resistance: Is Health Technology Assessment Part of the Solution or Part of the Problem? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1828-1834. [PMID: 34838281 DOI: 10.1016/j.jval.2021.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.
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Affiliation(s)
- Abigail R Colson
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK.
| | - Alec Morton
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo, Norway
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, England, UK
| | - Sally C Davies
- UK Department of Health and Social Care, London, England, UK
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England, UK
| | | | - Itamar Megiddo
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Chantal Morel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany; Department of Business Studies, Uppsala University, Uppsala, Sweden; Geneva Transformative Governance Lab, Science Faculty, University of Geneva, Geneva, Switzerland
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | | | - John H Rex
- F2G Limited, Eccles, Cheshire, UK and AMR Solutions, Boston, MA, USA
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, England, UK
| | - Beth Woods
- Centre for Health Economics, University of York, York, England, UK
| | - Yue Xiao
- China National Health Development Research Centre (National Centre for Medicine and Health Technology Assessment), Beijing, P. R. China
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Chen S, Kuhn M, Prettner K, Bloom DE, Wang C. Macro-level efficiency of health expenditure: Estimates for 15 major economies. Soc Sci Med 2021; 287:114270. [PMID: 34482274 PMCID: PMC8412416 DOI: 10.1016/j.socscimed.2021.114270] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic highlights the importance of strong and resilient health systems. Yet how much a society should spend on healthcare is difficult to determine because additional health expenditures imply lower expenditures on other types of consumption. Furthermore, the welfare-maximizing ("efficient") aggregate amount and composition of health expenditures depend on efficiency concepts at three levels that often get blurred in the debate. While the understanding of efficiency is good at the micro- and meso-levels-that is, relating to minimal spending for a given bundle of treatments and to the optimal mix of different treatments, respectively-this understanding rarely links to the efficiency of aggregate health expenditure at the macroeconomic level. While micro- and meso-efficiency are necessary for macro-efficiency, they are not sufficient. We propose a novel framework of a macro-efficiency score to assess welfare-maximizing aggregate health expenditure. This allows us to assess the extent to which selected major economies underspend or overspend on health relative to their gross domestic products per capita. We find that all economies under consideration underspend on healthcare with the exception of the United States. Underspending is particularly severe in China, India, and the Russian Federation. Our study emphasizes that the major and urgent issue in many countries is underspending on health at the macroeconomic level, rather than containing costs at the microeconomic level.
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Affiliation(s)
- Simiao Chen
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Michael Kuhn
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria; Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria
| | - Klaus Prettner
- Wittgenstein Centre (IIASA, OeAW, University of Vienna), Vienna Institute of Demography, Vienna, Austria; Vienna University of Economics and Business (WU), Department of Economics, Vienna, Austria
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chen Wang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Chinese Academy of Engineering, Beijing, China.
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Fornaro G, Federici C, Rognoni C, Ciani O. Broadening the Concept of Value: A Scoping Review on the Option Value of Medical Technologies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1045-1058. [PMID: 34243829 DOI: 10.1016/j.jval.2020.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 05/17/2023]
Abstract
OBJECTIVES A recent debate in health economics and outcomes research community identified option value as one of the elements warranting consideration in the assessment of medical technologies. To conduct a scoping review of contributions on option value in the healthcare sector and identify relevant conceptual aspects and methods used to incorporate it in standard economic evaluations. METHODS A systematic search was conducted up to July 2020 to identify contributions from electronic bibliographic database and gray literature. Data on the proposed definitions of option value, theoretical implications of its use in economic evaluations, and methods used to estimate it were extracted and analyzed. RESULTS We found 57 eligible studies. Three different definitions emerged: insurance value, real option value, and option value of survival. Focusing on the latter (24 studies), we analyzed in depth 8 empirical applications across 7 therapeutic areas. The most relevant methodological challenges were on the perspective used in economic evaluations and how to robustly manage forecasting uncertainty, update cost-effectiveness thresholds, and avoid double-counting issues. For empirical studies assessing the total value of the technology, including option value, estimates ranged from +7% to +469% of its conventional value. CONCLUSIONS This review synthesizes theoretical and empirical aspects on option value of healthcare technologies and proposes a terminology to distinguish 3 different concepts identified. Future work should focus primarily on agreeing on whether option value should be included in economic evaluations and, if so, on developing and validating reliable methods for its ex-ante estimation.
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Affiliation(s)
- Giulia Fornaro
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milano, Italy
| | - Carlo Federici
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milano, Italy; University of Warwick, School of Engineering, Coventry, England, UK.
| | - Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milano, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milano, Italy; Evidence Synthesis and Modelling for Health Improvement, College of Medicine and Health University of Exeter Medical School South Cloisters, Exeter, England, UK
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New Plant Breeding Technologies: An Assessment of the Political Economy of the Regulatory Environment and Implications for Sustainability. SUSTAINABILITY 2021. [DOI: 10.3390/su13073687] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This perspective discusses the impact of political economy on the regulation of modern biotechnology. Modern biotechnology has contributed to sustainable development, but its potential has been underexplored and underutilized. We highlight the importance of the impacts of regulations for investments in modern biotechnology and argue that improvements are possible via international harmonization of approval processes. This development is urgently needed for improving sustainable development. Policy makers in the European Union (EU) in particular are challenged to rethink their approach to regulating modern biotechnology as their decisions have far ranging consequences beyond the boundaries of the EU and they have the power to influence international policies.
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Simoens S, Spriet I. Guidance for Demonstrating the Societal Value of new Antibiotics. Front Pharmacol 2021; 11:618238. [PMID: 33597882 PMCID: PMC7882732 DOI: 10.3389/fphar.2020.618238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/11/2020] [Indexed: 11/13/2022] Open
Abstract
Given that antibiotic use is associated with externalities, standard economic evaluation which considers costs and health gains accruing to patients under-values antibiotics. Informed by a scoping review, this discussion paper aims to identify the societal value elements of antibiotics and to provide guidance on how these value elements can be incorporated in economic evaluation. With a view to appropriately quantify the societal value of antibiotics, there is a need for good practice guidelines on the methodology of economic evaluation for such products. We argue that it is important to assess antibiotics at population level to account for their transmission, diversity, insurance, spectrum, novel action and enablement values. In addition to the value of antibiotics to infected patients, economic evaluations need to use modeling approaches to explore the impact of different modes of employing new and existing antibiotics (for example, as last resort treatment) on disease transmission and resistance development in current and future patients. Hence, assessing the value of antibiotics also involves an ethical dimension. Further work is required about how the multiple value elements of antibiotics are linked to each other and how they can be aggregated.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Isabel Spriet
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium.,Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
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Evaluating for-profit public benefit corporations as an additional structure for antibiotic development and commercialization. Transl Res 2020; 220:182-190. [PMID: 32165059 DOI: 10.1016/j.trsl.2020.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/10/2020] [Accepted: 02/15/2020] [Indexed: 11/21/2022]
Abstract
While antibiotics are a key infrastructure underpinning modern medicine, evolution will continue to undermine their effectiveness, requiring continuous investment to sustain antibiotic effectiveness. The antibiotic R&D ecosystem is in peril, moving towards collapse. Key stakeholders have identified pull incentives such as Market Entry Rewards or subscription models as the key long-term solution. If substantial Market Entry Rewards or other pull incentives become possible, there is every reason to expect that for-profit companies will return to the antibiotic field. However, the political and financial will to develop such Market Entry Rewards or other similar incentives may be difficult to muster in the timeframes needed to prevent further diminishment of antibiotic research and development, especially if large drug companies are seen as substantial beneficiaries of these taxpayer-funded pull incentives. Bridging solutions are required from private actors in the interim. This article explores potential solutions led by private actors, including (1) traditional for-profit companies; (2) non-profit enterprises; and (3) public benefit corporations with lower profit expectations, akin to a public utility. All face similar commercial struggles, but nonprofits and public benefit corporations can accept lower profit expectations and might be more politically attractive recipients of pull incentives.
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Antibiotics in the clinical pipeline in October 2019. J Antibiot (Tokyo) 2020; 73:329-364. [PMID: 32152527 PMCID: PMC7223789 DOI: 10.1038/s41429-020-0291-8] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/27/2022]
Abstract
The development of new and effective antibacterial drugs to treat multi-drug resistant (MDR) bacteria, especially Gram-negative (G−ve) pathogens, is acknowledged as one of the world’s most pressing health issues; however, the discovery and development of new, nontoxic antibacterials is not a straightforward scientific task, which is compounded by a challenging economic model. This review lists the antibacterials, β-lactamase/β-lactam inhibitor (BLI) combinations, and monoclonal antibodies (mAbs) first launched around the world since 2009 and details the seven new antibiotics and two new β-lactam/BLI combinations launched since 2016. The development status, mode of action, spectra of activity, lead source, and administration route for the 44 small molecule antibacterials, eight β-lactamase/BLI combinations, and one antibody drug conjugate (ADC) being evaluated in worldwide clinical trials at the end of October 2019 are described. Compounds discontinued from clinical development since 2016 and new antibacterial pharmacophores are also reviewed. There has been an increase in the number of early stage clinical candidates, which has been fueled by antibiotic-focused funding agencies; however, there is still a significant gap in the pipeline for the development of new antibacterials with activity against β-metallolactamases, orally administered with broad spectrum G−ve activity, and new treatments for MDR Acinetobacter and gonorrhea.
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Abstract
Abstract
Storage policies are used in many countries to smooth price volatility and thereby support food security. When there is a global decrease in food supply caused by a number of extreme weather effects, food reserves are expected to reduce the potential negative implications for households with low purchasing power. In this paper, the properties of such a stockpiling policy are assessed and compared to a policy with storage but without stockpiling. The results show that a stockholding policy is an expensive strategy that generates economic benefits only in extreme cases.
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Holmes EAF, Hughes DA. Challenges for Economic Evaluation of Health Care Strategies to Contain Antimicrobial Resistance. Antibiotics (Basel) 2019; 8:antibiotics8040166. [PMID: 31569624 PMCID: PMC6963561 DOI: 10.3390/antibiotics8040166] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/15/2019] [Accepted: 09/24/2019] [Indexed: 11/16/2022] Open
Abstract
The threat of antimicrobial resistance has global health and economic consequences. Medical strategies to reduce unnecessary antibiotic prescribing, to conserve the effectiveness of current antimicrobials in the long term, inevitably result in short-term costs to health care providers. Economic evaluations of health care interventions therefore need to consider the short-term costs of interventions, to gain future benefits. This represents a challenge for health economists, not only in terms of the most appropriate methods for evaluation, but also in attributing the potential budget impact over time and considering health impacts on future populations. This commentary discusses the challenge of accurately capturing the cost-effectiveness of health care interventions aimed at tackling antimicrobial resistance. We reflect on methods to capture and incorporate the costs and health outcomes associated with antimicrobial resistance, the appropriateness of the quality-adjusted-life year (QALY), individual time preferences, and perspectives in economic evaluation.
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Affiliation(s)
- Emily A F Holmes
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Normal Site, Bangor, Gwynedd LL57 2PZ, UK.
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Normal Site, Bangor, Gwynedd LL57 2PZ, UK.
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Rex JH, Fernandez Lynch H, Cohen IG, Darrow JJ, Outterson K. Designing development programs for non-traditional antibacterial agents. Nat Commun 2019; 10:3416. [PMID: 31366924 PMCID: PMC6668399 DOI: 10.1038/s41467-019-11303-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/05/2019] [Indexed: 12/14/2022] Open
Abstract
In the face of rising rates of antibacterial resistance, many responses are being pursued in parallel, including 'non-traditional' antibacterial agents (agents that are not small-molecule drugs and/or do not act by directly targeting bacterial components necessary for bacterial growth). In this Perspective, we argue that the distinction between traditional and non-traditional agents has only limited relevance for regulatory purposes. Rather, most agents in both categories can and should be developed using standard measures of clinical efficacy demonstrated with non-inferiority or superiority trial designs according to existing regulatory frameworks. There may, however, be products with non-traditional goals focused on population-level benefits that would benefit from extension of current paradigms. Discussion of such potential paradigms should be undertaken by the development community.
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Affiliation(s)
- John H Rex
- F2G Limited, Eccles, Cheshire, M30 0LX, UK.
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
| | - Holly Fernandez Lynch
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - I Glenn Cohen
- Harvard Law School, Cambridge, MA, 02138, USA
- Petrie-Flom Center, Cambridge, MA, 02138, USA
| | | | - Kevin Outterson
- Boston University School of Law, CARB-X, Boston, MA, 02215, USA
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