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Xie F, Zhou T, Humphries B, Neumann PJ. Do Quality-Adjusted Life-Years Discriminate Against the Elderly? An Empirical Analysis of Published Cost-Effectiveness Analyses. Value Health 2024:S1098-3015(24)00126-8. [PMID: 38548176 DOI: 10.1016/j.jval.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES Critics of quality-adjusted life-years argue that it discriminates against older individuals. However, little empirical evidence has been produced to inform this debate. This study aimed to compare published cost-effectiveness analyses (CEAs) on patients aged ≥65 years and those aged <65 years. METHODS We used the Tufts Cost-Effectiveness Analysis Registry to identify CEAs published in MEDLINE between 1976 and 2021. Eligible CEAs were categorized according to age (≥65 years vs <65 years). The distributions of incremental cost-effectiveness ratios (ICERs) were compared between the age groups. We used logistic regression to assess the association between age groups and the cost-effectiveness conclusion adjusted for confounding factors. We conducted sensitivity analyses to explore the impact of mixed age and age-unknown groups and all ICERs from the same CEAs. Subgroup analyses were also conducted. RESULTS A total of 4445 CEAs categorized according to age <65 years (n = 3784) and age ≥65 years (n = 661) were included in the primary analysis. The distributions of ICERs and the likelihood of concluding that the intervention was cost-effective were similar between the 2 age groups. Adjusted odds ratios ranged from 1.132 (95% CI 0.930-1.377) to 1.248 (95% CI 0.970-1.606) (odds ratio >1 indicating that CEAs for age ≥65 years were more likely to conclude the intervention was cost-effective than those for age <65 years). Sensitivity and subgroup analyses found similar results. CONCLUSION Our analysis found no systematic differences in published ICERs using quality-adjusted life-years between CEAs for individuals aged ≥65 years and those for individuals aged <65 years.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Ting Zhou
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada; Center for Pharmacoeconomics and Outcome Research, China Pharmaceutical University, Nanjing, China
| | - Brittany Humphries
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Singh G, Corlin L, Beninger PR, Neumann PJ, Boumil MM, Mehta S, Salem DN. Attitudes on Equal Health Care Access versus Efficient Clinical Decisions across a Not-for-Profit Health Care System. Med Decis Making 2024; 44:18-27. [PMID: 37876181 DOI: 10.1177/0272989x231206750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Professional roles within a hospital system may influence attitudes behind clinical decisions. OBJECTIVE To determine participants' preferences about clinical decisions that either value equal health care access or efficiency. DESIGN Deidentified survey asking participants to choose between offering a low-cost screening test to a whole population ("equal access") or a more sensitive, expensive test that could be given to only half of the population but resulting in 10% more avoided deaths ("efficient"). Data collection took place from August 18, 2021, to January 24, 2022. Study 1644 was determined to be exempt by Tufts Health Sciences Institutional Review Board (IRB). SETTING Tufts Medicine Healthcare System. PARTICIPANTS Approximately 15,000 hospital employees received an e-mail from the Tufts Medicine Senior Vice President of Academic Integration. MEASUREMENTS Analysis of survey responses with chi-square and 1-sample t tests to determine the proportion who chose each option. Logistic regression models fit to examine relationships between professional role and test choice. RESULTS A total of 1,346 participants completed the survey (∼9.0% response rate). Overall, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%). However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choice. For example, among those in nonclinical roles, women were more likely than men to choose equal health care access. In multivariable analyses, having clinical roles was significantly associated with 1.73 times the likelihood of choosing equal access (95% confidence interval = 1.33-2.25). LIMITATIONS Generalizability concerns and survey question wording limit the study results. CONCLUSION Clinicians were more likely than nonclinicians to choose the equal health care access option, and health care administrators were more likely to choose efficiency. These differing attitudes can affect patient care and health care quality. HIGHLIGHTS Divergent preferences of valuing equal health care access and efficiency may be in conflict during clinical decision making.In this cross-sectional study that included 1,346 participants, approximately equal percentages of respondents chose the "equal access" (48%) and "efficient" option (52%), a nonsignificant difference. However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choiceSince clinicians were more likely than nonclinicians to choose the equal health care access option and health care administrators were more likely to choose efficiency, these differing attitudes can affect patient care and health care quality.
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Affiliation(s)
- Ganeev Singh
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, Medford, MA, USA
| | - Paul R Beninger
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Marcia M Boumil
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Shreya Mehta
- Tufts University School of Medicine, Boston, MA, USA
| | - Deeb N Salem
- Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
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Timbie JW, Reynolds KA, Evans EL, Brown DS, Cohen JW, Darien G, DeVoe JE, Grosse SD, Holve E, Meltzer DO, Merritt JG, Neumann PJ, Yabroff KR, Smith SR. Advancing Data Capacity for Economic Outcomes in Patient-Centered Outcomes Research: Challenges and Opportunities. Med Care 2023; 61:S161-S165. [PMID: 37963036 PMCID: PMC10635327 DOI: 10.1097/mlr.0000000000001901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
| | | | - Emily L. Evans
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
| | - Derek S. Brown
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Joel W. Cohen
- Agency for Healthcare Research and Quality, Rockville, MD
| | - Gwen Darien
- National Patient Advocate Foundation, Washington, DC
| | - Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin Holve
- Patient Centered Outcomes Research Institute, Washington, DC
| | - David O. Meltzer
- Departments of Economics and Medicine, University of Chicago Harris School of Public Policy, Chicago, IL
| | | | | | | | - Scott R. Smith
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
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Sullivan SD, Hernandez I, Ramsey SD, Neumann PJ. Has the Centers for Medicare & Medicaid Services Implicitly Adopted a Value Framework for Medicare Drug Price Negotiations? Value Health 2023; 26:1686-1688. [PMID: 37871678 DOI: 10.1016/j.jval.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Sean D Sullivan
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA; Department of Health Policy, London School of Economics and Political Science, London, England, UK; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Inmaculada Hernandez
- Division of Clinical Pharmacy, School of Pharmacy, University of California, San Diego, San Diego, CA, USA
| | - Scott D Ramsey
- The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts University, Boston, MA, USA
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Kim DD, Neumann PJ. Author Reply. Value Health 2023; 26:1578-1579. [PMID: 37419319 DOI: 10.1016/j.jval.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Affiliation(s)
- David D Kim
- Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Neumann PJ, Tunis SR. Turning CMS into a Health Technology Assessment Organization. N Engl J Med 2023; 389:682-684. [PMID: 37602545 DOI: 10.1056/nejmp2305280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
- Peter J Neumann
- From the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston (P.J.N., S.R.T.); and Rubix Health, Baltimore (S.R.T.)
| | - Sean R Tunis
- From the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston (P.J.N., S.R.T.); and Rubix Health, Baltimore (S.R.T.)
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Chambers JD, Clifford KA, Enright DE, Neumann PJ. Follow-On Indications for Orphan Drugs Related to the Inflation Reduction Act. JAMA Netw Open 2023; 6:e2329006. [PMID: 37581890 PMCID: PMC10427936 DOI: 10.1001/jamanetworkopen.2023.29006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/06/2023] [Indexed: 08/16/2023] Open
Abstract
This cohort study assesses rates at which orphan drugs approved by the US Food and Drug Administration were also approved for supplemental (follow-on) indications.
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Affiliation(s)
- James D. Chambers
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
| | - Katherine A. Clifford
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
| | - Daniel E. Enright
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
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Abstract
OBJECTIVES Health technology assessment (HTA) organizations vary in terms of how they conduct assessments. We assess whether and to what extent HTA bodies have adopted societal and novel elements of value in their economic evaluations. METHODS After categorizing "societal" and "novel" elements of value, we reviewed fifty-three HTA guidelines. We collected data on whether each guideline mentioned each societal or novel element of value, and if so, whether the guideline recommended the element's inclusion in the base case, sensitivity analysis, or qualitative discussion in the HTA. RESULTS The HTA guidelines mention on average 5.9 of the twenty-one societal and novel value elements we identified (range 0-16), including 2.3 of the ten societal elements and 3.3 of the eleven novel value elements. Only four value elements (productivity, family spillover, equity, and transportation) appear in over half of the HTA guidelines, whereas thirteen value elements are mentioned in fewer than one-sixth of the guidelines, and two elements receive no mention. Most guidelines do not recommend value element inclusion in the base case, sensitivity analysis, or qualitative discussion in the HTA. CONCLUSIONS Ideally, more HTA organizations will adopt guidelines for measuring societal and novel value elements, including analytic considerations. Importantly, simply recommending in guidelines that HTA bodies consider novel elements may not lead to their incorporation into assessments or ultimate decision making.
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Affiliation(s)
- Rachel Milstein Breslau
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Jose Diaz
- Bristol-Myers Squibb Pharmaceuticals Ltd., Uxbridge, UK
| | - Bill Malcolm
- Bristol-Myers Squibb Pharmaceuticals Ltd., Uxbridge, UK
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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Toumi M, Dabbous O, Aballéa S, Drummond MF, von der Schulenburg JMG, Malone DC, Neumann PJ, Sullivan SD, Tunis S. Recommendations for economic evaluations of cell and gene therapies: a systematic literature review with critical appraisal. Expert Rev Pharmacoecon Outcomes Res 2023; 23:483-497. [PMID: 37074838 DOI: 10.1080/14737167.2023.2197214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE No consensus exists on the ideal methodology to evaluate the economic impact and value of new, potentially curative gene therapies. We aimed to identify and describe published methodologic recommendations for the economic evaluation of gene therapies and assess whether these recommendations have been applied in published evaluations. METHODS This study was conducted in three stages: a systematic literature review of methodologic recommendations for economic evaluation of gene therapies; an assessment of the appropriateness of recommendations; and a review to assess the degree to which the recommendations were applied in published evaluations. RESULTS A total of 2,888 references were screened, 83 articles were reviewed to assess eligibility, and 20 papers were included. Fifty recommendations were identified, and 21 reached consensus thresholds. Most evaluations were based on naive treatment comparisons and did not apply consensus recommendations. Innovative payment mechanisms for gene therapies were rarely considered. The only widely applied recommendations related to modeling choices and methods. CONCLUSIONS Methodological recommendations for economic evaluations of gene therapies are generally not being followed. Assessing the applicability and impact of the recommendations from this study may facilitate the implementation of consensus recommendations in future evaluations.
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Affiliation(s)
- Mondher Toumi
- Laboratoire de Santé Publique, Aix-Marseille Université, Public Health Department, Marseille, France
| | - Omar Dabbous
- Global Geneconomics and Outcomes Research, Novartis Gene Therapies, Inc, Bannockburn, IL, USA
| | | | | | | | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Sean D Sullivan
- CHOICE Institute, University of Washington, Seattle, WA, USA
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Abstract
This study examines what study authors consider to be appropriate cost-effectiveness analysis thresholds as reflected in the referenced thresholds in their published cost-effectiveness analyses.
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Affiliation(s)
- Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, Massachusetts
| | - David D. Kim
- Department of Medicine, University of Chicago, Chicago, Illinois
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Kim DD, Do LA, Synnott PG, Lavelle TA, Prosser LA, Wong JB, Neumann PJ. Developing Criteria for Health Economic Quality Evaluation Tool. Value Health 2023:S1098-3015(23)02561-5. [PMID: 37068557 DOI: 10.1016/j.jval.2023.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES Because existing publication guidelines and checklists have limitations when used to assess the quality of cost-effectiveness analysis, we developed a novel quality assessment tool for cost-effectiveness analyses, differentiating methods and reporting quality and incorporating the relative importance of different quality attributes. METHODS We defined 15 quality domains from a scoping review and identified 72 methods and reporting quality attributes (36 each). After designing a best-worst scaling survey, we fielded an online survey to researchers and practitioners to estimate the relative importance of the attributes in February 2021. We analyzed the survey data using a sequential conditional logit model. The final tool included 48 quality attributes deemed most important for assessing methods and reporting quality (24 each), accompanied by a free and web-based scoring system. RESULTS A total of 524 participants completed the methodology section, and 372 completed both methodology and reporting sections. Quality attributes pertaining to the "modeling" and "data inputs and evidence synthesis" domains were deemed most important for methods quality, including "structure of the model reflects the underlying condition and intervention's impact" and "model validation is conducted." Quality attributes pertaining to "modeling" and "Intervention/comparator(s)" domains were considered most important for reporting quality, including "model descriptions are detailed enough for replication." Despite its growing prominence, "equity considerations" were not deemed as important as other quality attributes. CONCLUSIONS The Criteria for Health Economic Quality Evaluation tool allows users to differentiate methods and reporting as well as quantifies the relative importance of quality attributes. Alongside other considerations, it could help assess and improve the quality of cost-effectiveness evidence to inform value-based decisions.
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Affiliation(s)
- David D Kim
- Section of Hospital Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
| | - Lauren A Do
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Patricia G Synnott
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Lisa A Prosser
- The Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, Michigan Medicine, Ann Arbor, MI, USA; Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - John B Wong
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA; Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Olchanski N, Daly AT, Zhu Y, Breslau R, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM, Lin PJ. Alzheimer's disease medication use and adherence patterns by race and ethnicity. Alzheimers Dement 2023; 19:1184-1193. [PMID: 35939325 PMCID: PMC9905357 DOI: 10.1002/alz.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND We examined racial and ethnic differences in medication use for a representative US population of patients with Alzheimer's disease and related dementias (ADRD). METHODS We examined cholinesterase inhibitors and memantine initiation, non-adherence, and discontinuation by race and ethnicity, using data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. RESULTS Among newly diagnosed ADRD patients (n = 1299), 26% filled an ADRD prescription ≤90 days and 36% ≤365 days after diagnosis. Among individuals initiating ADRD-targeted treatment (n = 1343), 44% were non-adherent and 24% discontinued the medication during the year after treatment initiation. Non-Hispanic Blacks were more likely than Whites to not adhere to ADRD medication therapy (odds ratio: 1.50 [95% confidence interval: 1.07-2.09]). DISCUSSION Initiation of ADRD-targeted medications did not vary by ethnoracial group, but non-Hispanic Blacks had lower adherence than Whites. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care. HIGHLIGHTS Initiation of anti-dementia medications among newly diagnosed Alzheimer's disease and related dementias (ADRD) patients was low in all ethnoracial groups. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care. Compared to Whites, Blacks and Hispanics had lower use, poorer treatment adherence, and more frequent discontinuation of ADRD medication, but when controlling for disease severity and socioeconomic factors, racial disparities diminish. Our findings demonstrate the importance of adjusting for socioeconomic characteristics and disease severity when studying medication use and adherence in ADRD patients.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111
| | - Allan T. Daly
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
| | - Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
| | - Rachel Breslau
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, P.O. Box 1248, Ann Arbor, MI 48106
| | - Howard M. Fillit
- Alzheimer’s Drug Discovery Foundation, 57 West 57th St, Suite 904, New York, NY 10019
| | - Karen M. Freund
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA 02111
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111
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Chambers JD, Enright DE, Panzer AD, Cohen JT, Ollendorf DA, Neumann PJ. Examining US commercial health plans' use of The Institute for Clinical and Economic Review's reports in specialty drug coverage decisions. J Manag Care Spec Pharm 2023; 29:257-264. [PMID: 36840954 PMCID: PMC10387943 DOI: 10.18553/jmcp.2023.29.3.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND: The Institute for Clinical and Economic Review (ICER) has emerged in a visible role in US health care. However, it is unclear to what extent US commercial health plans use ICER value assessments in their specialty drug coverage decisions. OBJECTIVE: To evaluate the relationship between ICER's reported cost-effectiveness ratios (CERs) and coverage restrictiveness. Also, to examine the frequency with which plans have cited ICER in their coverage policies and to investigate how frequently health plans adjusted their drug coverage criteria in the 12 months after ICER's assessments. METHODS: We analyzed the Tufts Medical Center Specialty Drug Evidence and Coverage Database, which includes specialty drug coverage decisions issued by 17 large US commercial health plans. For ICER-assessed drugs, we recorded ICER's estimated CERs in the form of cost per quality-adjusted life-year (QALY) gained. First, we used multivariate logistic regression to examine the association between ICER's reported CERs and plan coverage restrictiveness, when controlling for other factors that were likely to affect decision-making. Next, we examined how often plans cited ICER's assessments in coverage decisions issued in years 2017-2020. Lastly, we examined whether plans added or removed coverage restrictions (eg, patient subgroup restrictions or step therapy protocols) in the 12 months following ICER's assessment. RESULTS: Plans tended to cover drugs with higher (less favorable) CERs more restrictively than drugs with CERs less than $100,000 per QALY: odds ratio (OR) = 4.48 if $100,000-$175,000 per QALY; OR = 2.00 if $175,000-$500,000 per QALY; and OR = 2.10 if $500,000 or more per QALY (all P < 0.01). Plans cited ICER in 0.8% (5/622) of coverage policies in 2017, 0.6% (5/833) in 2018, 1.7% (19/1,139) in 2019, and 2.4% (33/1,406) in 2020. For drugs with CERs less than $175,000 per QALY, plans adjusted coverage in 37% of cases: added restrictions in 20%, removed restrictions in 15%, and added one restriction but removed another in 2%. For drugs with CERs of $175,000 or more, plans changed coverage criteria in 29% of cases: added restrictions in 21%, removed restrictions in 5%, and added one restriction but removed another in 4%. CONCLUSIONS: We found that when controlling for other factors, health plans' specialty drug coverage decisions were associated with ICER's estimated CERs. Plans infrequently cited ICER value assessments. We did not observe a trend for plans more often narrowing coverage criteria for drugs with CERs $175,000 or more compared with drugs with CERs less than $175,000. DISCLOSURES: This research study was supported by a consortium of funders: Amgen, Genen-tech, Janssen Pharmaceuticals, Otsuka, and GSK.
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Affiliation(s)
- James D Chambers
- The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Daniel E Enright
- The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Ari D Panzer
- The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Josh T Cohen
- The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Daniel A Ollendorf
- The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Peter J Neumann
- The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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Zhu Y, Olchanski N, Cohen JT, Freund KM, Faul JD, Fillit HM, Neumann PJ, Lin PJ. Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life. J Alzheimers Dis 2023; 96:1183-1193. [PMID: 37955089 PMCID: PMC10777481 DOI: 10.3233/jad-230692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Older adults with dementia including Alzheimer's disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits. OBJECTIVE This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia. METHODS This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions. RESULTS Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences. CONCLUSIONS Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.
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Affiliation(s)
- Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Karen M. Freund
- Center for Health Equity Research, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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15
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Zhu Y, Olchanski N, Freund KM, Faul JD, Fillit HM, Breslau RM, Cohen JT, Neumann PJ, Lin P. End‐of‐life burdensome interventions among Medicare fee‐for‐service beneficiaries with no dementia, non‐advanced dementia, and advanced dementia. Alzheimers Dement 2022; 18 Suppl 9:e063807. [DOI: 10.1002/alz.063807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Natalia Olchanski
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | - Karen M Freund
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | | | | | | | - Joshua T Cohen
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | - Peter J Neumann
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | - Pei‐Jung Lin
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
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16
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Lin P, Zhu Y, Olchanski N, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM. Racial and Ethnic Differences in Hospice Use and End‐of‐life Hospitalizations among Medicare Beneficiaries with Dementia. Alzheimers Dement 2022. [DOI: 10.1002/alz.062289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Pei‐Jung Lin
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | | | - Natalia Olchanski
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | - Joshua T Cohen
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | - Peter J Neumann
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
| | | | - Howard M Fillit
- Alzheimer’s Drug Discovery Foundation New York NY USA
- Geriatric Medicine, Palliative Care and Neuroscience, The Icahn School of Medicine at Mount Sinai New York NY USA
| | - Karen M Freund
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
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17
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Ferrell PB, Fillit H, Neumann PJ, Wall JK, Murray JF. Toward comprehensive value assessment for Alzheimer's disease innovations. Alzheimers Dement 2022; 19:1558-1567. [PMID: 36427013 DOI: 10.1002/alz.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Assessing medical technologies for Alzheimer's disease (AD) creates challenges for current methods of value assessment. New value assessment approaches for AD are also needed. METHODS We adapted concepts from health economics to help guide decision makers to more informed decisions about AD therapies and diagnostics. RESULTS We propose a value framework based on five categories: perspective, value elements, analysis, reporting, and decision making. AD value assessments should include the perspective of the patient-caregiver dyad. We propose a broader array of value elements than currently used. Analytics and decision methods can synthesize evidence for all elements of value. Decisions should use a "deliberative appraisal" approach informed by the composite evidence and be transparently reported. DISCUSSION Using the proposed framework, the value of forthcoming innovations for AD may be more thoroughly assessed for and by all stakeholders. It can guide decision makers to carefully consider all relevant elements of value contributing to more holistic and transparent decision making. RESEARCH HIGHLIGHTS Alzheimer's disease challenges common methods of evaluating medical technology. Using current methods, new AD innovations might not be appropriately valued. Poor value assessments will adversely affect patient access to AD innovations. A full AD value framework expands perspective, elements, analysis, decision-making, reporting.
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Affiliation(s)
| | - Howard Fillit
- Alzheimer's Drug Discovery Foundation and Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health Tufts Medical Center Boston Massachusetts USA
| | - J. K. Wall
- Eli Lilly and Company Lilly Corporate Center Indianapolis Indiana USA
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18
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Breslau RM, Cohen JT, Ollendorf DA, Neumann PJ. Should Drug Companies Engage with ICER? An Empirical Analysis of How Often Manufacturers Engage with ICER and Whether Engagement May Influence ICER's Cost-Effectiveness Estimates. Pharmacoecon Open 2022; 6:893-895. [PMID: 35871128 PMCID: PMC9596652 DOI: 10.1007/s41669-022-00358-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Rachel Milstein Breslau
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA, 02111, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, #063, Boston, MA, 02111, USA.
- Department of Medicine, Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA.
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19
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Kim DD, Daly AT, Koethe BC, Fendrick AM, Ollendorf DA, Wong JB, Neumann PJ. Low-Value Prostate-Specific Antigen Test for Prostate Cancer Screening and Subsequent Health Care Utilization and Spending. JAMA Netw Open 2022; 5:e2243449. [PMID: 36413364 PMCID: PMC9682424 DOI: 10.1001/jamanetworkopen.2022.43449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Delivering low-value care can lead to unnecessary follow-up services and associated costs, and such care cascades have not been well examined in common clinical scenarios. OBJECTIVE To evaluate the utilization and costs of care cascades of prostate-specific antigen (PSA) tests for prostate cancer screening, as the routine use of which among asymptomatic men aged 70 years and older is discouraged by multiple guidelines. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included men aged 70 years and older without preexisting prostate conditions enrolled in a Medicare Advantage plan during January 2016 to December 2018 with at least 1 outpatient visit. Medical billing claims data from the deidentified OptumLabs Data Warehouse were used. Data analysis was conducted from September 2020 to August 2021. EXPOSURES At least 1 claim for low-value PSA tests for prostate cancer screening during the observation period. MAIN OUTCOMES AND MEASURES Utilization of and spending on low-value PSA cancer screening and associated care cascades and the difference in overall health care utilization and spending among individuals receiving low-value PSA cancer screening vs those who did not, adjusting for observed characteristics using inverse probability of treatment weighting. RESULTS Of 995 442 men (mean [SD] age, 78.0 [5.6] years) aged 70 years or older in a Medicare Advantage plan included in this study, 384 058 (38.6%) received a low-value PSA cancer screening. Utilization increased for each subsequent cohort from 2016 to 2018 (49 802 of 168 951 [29.4%] to 134 404 of 349 228 [38.5%] to 199 852 of 477 203 [41.9%]). Among those receiving initial low-value PSA cancer screening, 241 188 of 384 058 (62.8%) received at least 1 follow-up service. Repeated PSA testing was the most common, and 27 268 (7.1%) incurred high-cost follow-up services, such as imaging, radiation therapy, and prostatectomy. Utilization and spending associated with care cascades also increased from 2016 to 2018. For every $1 spent on a low-value PSA cancer screening, an additional $6 was spent on care cascades. Despite avoidable care cascades, individuals who received low-value PSA cancer screening were not associated with increased overall health care utilization and spending during the 1-year follow-up period compared with an unscreened population. CONCLUSIONS AND RELEVANCE In this cross-sectional study, low-value PSA tests for prostate cancer screening remained prevalent among Medicare Advantage plan enrollees and were associated with unnecessary expenditures due to avoidable care cascades. Innovative efforts from clinicians and policy makers, such as payment reforms, to reduce initial low-value care and avoidable care cascades are warranted to decrease harm, enhance equity, and improve health care efficiency.
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Affiliation(s)
- David D. Kim
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies (ICRHPS), Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Allan T. Daly
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies (ICRHPS), Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Benjamin C. Koethe
- Biostatistics, Epidemiology, and Research Design (BERD) Center, ICRHPS, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - A. Mark Fendrick
- Department of Internal Medicine and Health Management and Policy, University of Michigan, Ann Arbor
| | - Daniel A. Ollendorf
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies (ICRHPS), Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - John B. Wong
- Tufts University School of Medicine, Boston, Massachusetts
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies (ICRHPS), Department of Medicine, Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
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20
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Lavelle TA, Feng X, Keisler M, Cohen JT, Neumann PJ, Prichard D, Schroeder BE, Salyakina D, Espinal PS, Weidner SB, Maron JL. Response to Grosse and Gudgeon. Genet Med 2022; 24:2597-2598. [PMID: 36166002 DOI: 10.1016/j.gim.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA.
| | - Xue Feng
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Marlena Keisler
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | | | | | - Daria Salyakina
- Personalized Medicine and Health Outcomes Research, Nicklaus Children's Hospital, Miami, FL
| | - Paula S Espinal
- Personalized Medicine and Health Outcomes Research, Nicklaus Children's Hospital, Miami, FL
| | - Samuel B Weidner
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Jill L Maron
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI
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21
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Do LA, Koethe BC, Daly AT, Chambers JD, Ollendorf DA, Wong JB, Fendrick AM, Neumann PJ, Kim DD. State-Level Variation In Low-Value Care For Commercially Insured And Medicare Advantage Populations. Health Aff (Millwood) 2022; 41:1281-1290. [PMID: 36067429 DOI: 10.1377/hlthaff.2022.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Low-value care is a major source of health care inefficiency in the US. Our analysis of 2009-19 administrative claims data from OptumLabs Data Warehouse found that low-value care and associated spending remain prevalent among commercially insured and Medicare Advantage enrollees. The aggregated prevalence of twenty-three low-value services was 1,920 per 100,000 eligible enrollees, which amounted to $3.7 billion in wasteful expenditures during the study period. State-level variation in spending was greater than variation in utilization, and much of the variation in spending was driven by differences in average procedure prices. If the average price for twenty-three low-value services among the top ten states in spending were set to the national average, their spending would decrease by 19.8 percent (from $735,000 to $590,000 per 100,000 eligible enrollees). State-level actions to improve the routine measurement and reporting of low-value care could identify sources of variation and help design state-specific policies that lead to better patient-centered outcomes, enhanced equity, and more efficient spending.
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Affiliation(s)
- Lauren A Do
- Lauren A. Do, Tufts Medical Center, Boston, Massachusetts
| | | | | | - James D Chambers
- James D. Chambers, Tufts Medical Center and Tufts University, Boston, Massachusetts
| | | | - John B Wong
- John B. Wong, Tufts Medical Center and Tufts University
| | - A Mark Fendrick
- A. Mark Fendrick, University of Michigan, Ann Arbor, Michigan
| | | | - David D Kim
- David D. Kim , Tufts Medical Center and Tufts University
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22
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Podolsky MI, Present I, Neumann PJ, Kim DD. A Systematic Review of Economic Evaluations of COVID-19 Interventions: Considerations of Non-Health Impacts and Distributional Issues. Value Health 2022; 25:1298-1306. [PMID: 35398012 PMCID: PMC8986127 DOI: 10.1016/j.jval.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/04/2022] [Accepted: 02/01/2022] [Indexed: 05/07/2023]
Abstract
OBJECTIVES This study aims to conduct a systematic review of economic evaluations of COVID-19 interventions and to examine whether and how these studies incorporate non-health impacts and distributional concerns. METHODS We searched the National Institutes of Health's COVID-19 Portfolio as of May 20, 2021, and supplemented our search with additional sources. We included original articles, including preprints, evaluating both the health and economic effects of a COVID-19-related intervention. Using a pre-specified data collection form, 2 reviewers independently screened, reviewed, and extracted information about the study characteristics, intervention types, and incremental cost-effectiveness ratios (ICERs). We used an Impact Inventory to catalog the types of non-health impacts considered. RESULTS We included 70 articles, almost half of which were preprints. Most articles (56%) included at least one non-health impact, but fewer (21%) incorporated non-economic consequences. Few articles (17%) examined subgroups of interest. After excluding negative ICERs, the median ICER for the entire sample (n = 243 ratios) was $67,000/quality-adjusted life-year (QALY) (interquartile range [IQR] $9000-$893,000/QALY). Interventions including a pharmaceutical component yielded a median ICER of $93,000/QALY (IQR $4000-$7,809,000/QALY), whereas interventions including a non-pharmaceutical component were slightly more cost-effective overall with a median ICER of $81,000/QALY (IQR $12,000-$1,034,000/QALY). Interventions reported to be highly cost-effective were treatment, public information campaigns, quarantining identified contacts/cases, canceling public events, and social distancing. CONCLUSIONS Our review highlights the lack of consideration of non-health and distributional impacts among COVID-19-related economic evaluations. Accounting for non-health impacts and distributional effects is essential for comprehensive assessment of interventions' value and imperative for generating cost-effectiveness evidence for both current and future pandemics.
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Affiliation(s)
- Meghan I Podolsky
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Isabel Present
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
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23
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Ma S, Olchanski N, Cohen JT, Ollendorf DA, Neumann PJ, Kim DD. The Impact of Broader Value Elements on Cost-Effectiveness Analysis: Two Case Studies. Value Health 2022; 25:1336-1343. [PMID: 35315331 DOI: 10.1016/j.jval.2022.01.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/29/2021] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to explore the impact of including broader value elements in cost-effectiveness analyses by presenting 2 case studies, one on human papillomavirus (HPV) infection and one on early-stage Hodgkin's lymphoma (ESHL). METHODS We identified broader value elements (eg, patient and caregiver time, spillover health effects, productivity) from the Second Panel's Impact Inventory and the ISPOR Special Task Force's value flower. We then evaluated the cost-effectiveness of HPV vaccination versus no vaccination (case 1) and combined modality therapy (CMT) versus chemotherapy alone for treatment of adult ESHL (case 2) using published simulation models. For each case study, we compared incremental cost-effectiveness ratios considering health sector impacts only (the "base-case" scenario) with incremental cost-effectiveness ratios incorporating broader value elements. RESULTS For vaccination of US girls against HPV before sexual debut versus no vaccination, the base-case result was $38 334 per disability-adjusted life-year averted. Including each broader value element made cost-effectiveness progressively more favorable, with HPV vaccination becoming cost-saving (ie, reducing costs and averting more disability-adjusted life-years) when the analysis incorporated productivity costs. For CMT versus chemotherapy alone in patients with ESHL, the base-case result indicated that CMT was cost-saving. Including all elements made this treatment's net monetary benefits (the sum of its averted resource costs and the net value of its health impacts) less favorable, even as the contribution from CMT's near-term health benefits grew. CONCLUSIONS Including broader value elements can substantially influence cost-effectiveness ratios, although the direction and the magnitude of their impact can differ across interventions and disease context.
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Affiliation(s)
- Siyu Ma
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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24
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Hlávka JP, Lavelle TA, Neumann PJ, Lin PJ. Addressing Challenges to Alternative Payment Models for New Alzheimer's Disease Therapies for US Commercial Payers. Pharmacoeconomics 2022; 40:647-652. [PMID: 35553029 PMCID: PMC10372750 DOI: 10.1007/s40273-022-01150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
Commercial payers that ultimately decide to cover aducanumab or other Alzheimer's disease therapies may require innovative payment tools to minimize their financial risk given the uncertain benefits and high cost of such treatments. Drawing on the published evidence, we propose two different types of payment models applicable to disease-modifying therapies in Alzheimer's disease, and suggest four strategies to overcome challenges in their implementation. Such strategies range from developing best practices for outcome measurement in Alzheimer's disease, investing in infrastructure to collect real-world data, increasing representativeness of registry data in Alzheimer's disease, and integrating the diagnostic, treatment, and payment landscape. These important steps could make access to emerging therapies in Alzheimer's disease more sustainable in the long term, and could serve as a blueprint for better access to novel therapies in other indications in the future.
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Affiliation(s)
- Jakub P Hlávka
- Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA.
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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25
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Lavelle TA, Feng X, Keisler M, Cohen JT, Neumann PJ, Prichard D, Schroeder BE, Salyakina D, Espinal PS, Weidner SB, Maron JL. Cost-effectiveness of exome and genome sequencing for children with rare and undiagnosed conditions. Genet Med 2022; 24:1349-1361. [PMID: 35396982 DOI: 10.1016/j.gim.2022.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to estimate the cost-effectiveness of exome sequencing (ES) and genome sequencing (GS) for children. METHODS We modeled costs, diagnoses, and quality-adjusted life years (QALYs) for diagnostic strategies for critically ill infants (aged <1 year) and children (aged <18 years) with suspected genetic conditions: (1) standard of care (SOC) testing, (2) ES, (3) GS, (4) SOC followed by ES, (5) SOC followed by GS, (6) ES followed by GS, and (7) SOC followed by ES followed by GS. We calculated the 10-year incremental cost per additional diagnosis, and lifetime incremental cost per QALY gained, from a health care perspective. RESULTS First-line GS costs $15,048 per diagnosis vs SOC for infants and $27,349 per diagnosis for children. If GS is unavailable, ES represents the next most efficient option compared with SOC ($15,543 per diagnosis for infants and $28,822 per diagnosis for children). Other strategies provided the same or fewer diagnoses at a higher incremental cost per diagnosis. Lifetime results depend on the patient's assumed long-term prognosis after diagnosis. For infants, GS ranged from cost-saving (vs all alternatives) to $18,877 per QALY (vs SOC). For children, GS (vs SOC) ranged from $119,705 to $490,047 per QALY. CONCLUSION First-line GS may be the most cost-effective strategy for diagnosing infants with suspected genetic conditions. For all children, GS may be cost-effective under certain assumptions. ES is nearly as efficient as GS and hence is a viable option when GS is unavailable.
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Affiliation(s)
- Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA.
| | - Xue Feng
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA
| | - Marlena Keisler
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA
| | | | | | - Daria Salyakina
- Personalized Medicine and Health Outcomes Research, Nicklaus Children's Hospital, Miami, FL
| | - Paula S Espinal
- Personalized Medicine and Health Outcomes Research, Nicklaus Children's Hospital, Miami, FL
| | - Samuel B Weidner
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA
| | - Jill L Maron
- Women & Infants Hospital of Rhode Island, Care New England Health System, Providence, RI
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Lin PJ, Zhu Y, Olchanski N, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM. Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia. JAMA Netw Open 2022; 5:e2216260. [PMID: 35679046 PMCID: PMC9185179 DOI: 10.1001/jamanetworkopen.2022.16260] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IMPORTANCE The pool of studies examining ethnic and racial differences in hospice use and end-of-life hospitalizations among patients with dementia is limited and results are conflicting, making it difficult to assess health care needs of underresourced racial and ethnic groups. OBJECTIVE To explore differences in end-of-life utilization of hospice and hospital services among patients with dementia by race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS This cohort study used national survey data from the Health and Retirement Study linked with Medicare and Medicaid claims that reflected a range of socioeconomic, health, and psychosocial characteristics. Eligible participants were Medicare fee-for-service beneficiaries aged 65 years or older diagnosed with dementia who died between 2000 and 2016. Analyses were performed from June to December 2021. EXPOSURES Race and ethnicity. MAIN OUTCOMES AND MEASURES We examined the frequency and costs of hospice care, emergency department (ED) visits, and hospitalizations during the last 180 days of life among Medicare decedents with dementia. We analyzed the proportion of dementia decedents with advance care planning and their end-of-life care preferences. RESULTS The cohort sample included 5058 beneficiaries with dementia (mean [SD] age, 85.5 [8.0] years; 3038 women [60.1%]; 809 [16.0%] non-Hispanic Black, 357 [7.1%] Hispanic, and 3892 non-Hispanic White respondents [76.9%]). In adjusted analysis, non-Hispanic Black decedents (odds ratio [OR], 0.65; 95% CI, 0.55-0.78), nursing home residents (OR, 0.81; 95% CI, 0.71-0.93), and survey respondents represented by a proxy (OR, 0.84; 95% CI, 0.71-0.99) were less likely to use hospice, whereas older decedents (age 75-84 vs 65-74 years: OR, 1.39; 95% CI, 1.12-1.72; age ≥85 vs 65-74 years: OR, 1.39; 95% CI, 1.13-1.71), women (OR, 1.19; 95% CI, 1.05-1.35), and decedents with higher education (high school vs less than high school: OR, 1.17; 95% CI, 1.01-1.36; more than high school vs less than high school: OR, 1.32; 95% CI, 1.13-1.54), more severe cognitive impairment (OR, 1.51; 95% CI, 1.02-2.23), and more instrumental activities of daily living limitations (OR, 1.07; 95% CI, 1.01-1.12) were associated with higher hospice enrollment. A higher proportion of Black and Hispanic decedents with dementia used ED (645 of 809 [79.7%] and 274 of 357 [76.8%] vs 2753 of 3892 [70.7%]; P < .001) and inpatient services (625 of 809 [77.3%] and 275 of 357 [77.0%] vs 2630 of 3892 [67.5%]; P < .001) and incurred roughly 60% higher inpatient expenditures at the end of life compared with White decedents (estimated mean: Black, $23 279; 95% CI, $20 690-$25 868; Hispanic, $23 471; 95% CI, $19 532-$27 410 vs White, $14 609; 95% CI, $13 800-$15 418). A higher proportion of Black and Hispanic than White beneficiaries with dementia who were enrolled in hospice were subsequently admitted to the ED (56 of 309 [18.1%] and 22 of 153 [14.4%] vs 191 of 1967 [9.7%]; P < .001) or hospital (48 of 309 [15.5%] and 17 of 153 [11.1%] vs 119 of 1967 [6.0%]; P < .001) before death. The proportion of dementia beneficiaries completing advance care planning was lower among Black (146 of 704 [20.7%]) and Hispanic (66 of 308 [21.4%]) beneficiaries compared with White beneficiaries (1871 of 3274 [57.1%]). A higher proportion of Black and Hispanic decedents with dementia had written instructions choosing all care possible to prolong life (30 of 144 [20.8%] and 12 of 65 [18.4%] vs 72 of 1852 [3.9%]), whereas a higher proportion of White decedents preferred to limit care in certain situations (1708 of 1840 [92.8%] vs 114 of 141 [80.9%] and 51 of 64 [79.7%]), withhold treatments (1448 of 1799 [80.5%] vs 87 of 140 [62.1%] and 41 of 62 [66.1%]), and forgo extensive life-prolonging measures (1712 of 1838 [93.1%] vs 120 of 138 [87.0%] and 54 of 65 [83.1%]). CONCLUSIONS AND RELEVANCE The results of this cohort study highlight unique end-of-life care utilization and treatment preferences across racial and ethnic groups among patients with dementia. Medicare should consider alternative payment models to promote culturally competent end-of-life care and reduce low-value interventions and costs among the population with dementia.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Karen M. Freund
- Center for Health Equity Research, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
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Neumann PJ, Garrison LP, Willke RJ. The History and Future of the "ISPOR Value Flower": Addressing Limitations of Conventional Cost-Effectiveness Analysis. Value Health 2022; 25:558-565. [PMID: 35279370 DOI: 10.1016/j.jval.2022.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Since its publication as part of the 2018 ISPOR Special Task Force (STF) on US Value Assessments, the "ISPOR value flower," with its petals highlighting elements that may be overlooked or underappreciated in conventional drug value assessments, has been discussed and debated. We review the history of the value flower, describe recent developments, and consider implications for future value assessments. METHODS We discuss various antecedents to the value flower, as well as conceptual and empirical articles published in the past 4 years. RESULTS Since the publication of the ISPOR STF report, researchers have provided more rigorous theoretical and mathematical foundations for certain novel value elements (eg, severity of illness, value of insurance, value of hope) through "generalized risk-adjusted cost-effectiveness analysis," which incorporates risk aversion in people's preferences and uncertainty in treatment outcomes. Empirical estimates are also emerging to support key elements, such as insurance value, real option value, value of hope, and value of knowing. Although health technology assessment bodies have applied or are considering certain elements (eg, severity modifiers to cost-effectiveness thresholds), other elements have yet to gain traction. CONCLUSIONS Five years after the STF began its work, the development of novel value measures continues to evolve. Although it is encouraging to see supporting empirical studies emerging, more are needed. Additional efforts are also needed to illustrate how the estimates can be used in the deliberative processes that are integral to health technology assessments.
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Affiliation(s)
- Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Health at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Louis P Garrison
- Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, WA, USA
| | - Richard J Willke
- The International Society for Pharmacoeconomics and Outcomes Research, Lawrenceville, NJ, USA
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Chambers JD, Silver MC, Berklein FC, Cohen JT, Neumann PJ. Are Medical Devices Cost-Effective? Appl Health Econ Health Policy 2022; 20:235-241. [PMID: 34820784 DOI: 10.1007/s40258-021-00698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Medical devices can offer important therapeutic advances but, as for any medical interventions, there are questions about their costs and benefits. We examined health benefits and costs for pre-market approved (PMA) devices approved by the US Food and Drug Administration (FDA) (1999-2015), grouping them by generic category (e.g., drug-eluting stents) and indication. METHODS We searched PubMed for incremental health gain estimates [measured in quality-adjusted life-years (QALYs)] and incremental costs for each device category compared to previously available treatments. We calculated incremental cost-effectiveness ratios by dividing the average incremental costs by the average incremental QALY gains. In sensitivity analysis, we repeated the analysis when excluding industry-funded studies. RESULTS We identified at least one relevant cost-utility or comparative-effectiveness study for 88 devices (15.9% of non-cosmetic devices approved from 1999 to 2015), and at least one device across 53 (26.2%) generic categories. The median (mean) incremental cost across generic device categories was $1701 ($13,320). The median (mean) incremental health gain across generic device categories was 0.13 (0.46) QALYs. We found that cost-effectiveness ratios for 36 of 53 (68%) and 43 of 53 (81%) device categories fell below (were more favorable than) $50,000 and $150,000 per QALY, respectively. Results were roughly similar when we excluded industry-funded studies. CONCLUSIONS We found that roughly one-quarter of the major PMA medical device categories have published cost-effectiveness evidence accessible through a large, publicly available database. Available evidence suggests that devices generally offer good value, as judged relative to established cost-effectiveness benchmarks.
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Affiliation(s)
- James D Chambers
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA.
| | - Madison C Silver
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
| | - Flora C Berklein
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, 35 Kneeland St., Boston, MA, 02111, USA
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O'Hara J, Neumann PJ. Health technology assessment for gene therapies in haemophilia. Haemophilia 2022; 28 Suppl 2:19-26. [DOI: 10.1111/hae.14413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 08/31/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Jamie O'Hara
- HCD Economics Daresbury UK
- University of Chester Chester UK
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies, Tufts Medical Centre Boston Massachusetts USA
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Neumann PJ, Podolsky MI, Basu A, Ollendorf DA, Cohen JT. Do Cost-Effectiveness Analyses Account for Drug Genericization? A Literature Review and Assessment of Implications. Value Health 2022; 25:59-68. [PMID: 35031100 DOI: 10.1016/j.jval.2021.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES We investigated how health technology assessment (HTA) organizations around the world have handled drug genericization (an allowance for future generic drug entry and subsequent drug price declines) in their guidelines for cost-effectiveness analyses (CEAs). We also analyzed a large sample of published CEAs to examine prevailing practices in the field. METHODS We reviewed 43 HTA guidelines to determine whether and how they addressed drug genericization in their CEAs. We also selected a sample of 270 US-based CEAs from the Tufts Medical Center's CEA Registry, restricting the sample to studies on pharmaceuticals published from 1991 to 2019 and to analyses taking a lifetime time horizon. We determined whether each CEA examined genericization (and if so, whether in base case or sensitivity analyses), and how inclusion of genericization influenced the estimated incremental cost-effectiveness ratios. RESULTS Fourteen (33%) of the 43 HTA guidelines mention genericization for CEAs and 4 (9%) recommend that base case analyses include assumptions about future drug price changes due to genericization. Most published CEAs (95%) do not include assumptions about future generic prices for intervention drugs. Only 2% include such assumptions about comparator drugs. Most studies (72%) conduct sensitivity analyses on drug prices unrelated to genericization. CONCLUSIONS The omission of assumptions about genericization means that CEAs may misrepresent the long run opportunity costs for drugs. The field needs clearer guidance for when CEAs should account for genericization, and for the inclusion of other price dynamics that might influence a drug's cost-effectiveness.
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Affiliation(s)
- Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA.
| | - Meghan I Podolsky
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
| | - Anirban Basu
- The CHOICE Institute, University of Washington, Seattle, WA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
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Voehler D, Neumann PJ, Ollendorf DA. Patient and Caregiver Views on Measures of the Value of Health Interventions. Patient Prefer Adherence 2022; 16:3383-3392. [PMID: 36573224 PMCID: PMC9789716 DOI: 10.2147/ppa.s390227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We aimed to investigate patient and caregiver views on the relative importance of traditional and nontraditional domains of value, and to determine if these views differed according to key demographic characteristics. PATIENTS AND METHODS We conducted a modified Delphi approach using a web-based survey of adult patients managing a chronic condition or caregivers of a patient with chronic illness who were recruited using purposive sampling focused on demographic and clinical characteristics. The first survey round asked participants to rate the 13 domains of value on a 5-point Likert scale and rank each domain that they rated as important or very important. In the second survey round, participants reconsidered their own and aggregated round 1 results. New questions were added, including "rescuing" domains, challenges faced in taking medication, and a free-text option to add domains not already captured. RESULTS Initial recruitment resulted in 79 participants. Sixty-three (79.7%) completed the first round, and 58 participants completed both rounds. Overall ratings and rankings were consistent between survey rounds, and respondents ranked most highly domains considered traditional domains of value (for example, survival, costs). Patient activists were about six times more likely to rate each domain as important or very important compared to general disease advocates. Significant factors associated with a higher odds of rating a domain as important or very important were age 35-54 and 55-64 compared to 18-34, while factors associated with a decreased odds were males and patients compared to caregivers. CONCLUSION Patients and caregivers place significant emphasis on traditional measures of value compared to nontraditional measures, and participants' prior beliefs impact what aspects of value they deem important.
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Affiliation(s)
- Dominic Voehler
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Correspondence: Daniel A Ollendorf, Tufts Medical Center, 800 Washington St., #063, Boston, MA, 02111, USA, Tel +1 617 636 2581, Email
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Neumann PJ, Ollendorf DA, Cohen JT. Value-based drug pricing in the Biden era: Opportunities and prospects. Health Serv Res 2021; 56:1093-1099. [PMID: 34085289 PMCID: PMC8586482 DOI: 10.1111/1475-6773.13686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts University School of Medicine, Boston, Massachusetts, USA
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Lin P, Daly A, Olchanski N, Zhu Y, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM. Alzheimer’s disease medication utilization patterns: Disparities in treatment initiation, non‐adherence, and discontinuation. Alzheimers Dement 2021. [DOI: 10.1002/alz.054849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- Peter J Neumann
- From the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston
| | - Joshua T Cohen
- From the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston
| | - Daniel A Ollendorf
- From the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston
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Tunis S, Hanna E, Neumann PJ, Toumi M, Dabbous O, Drummond M, Fricke FU, Sullivan SD, Malone DC, Persson U, Chambers JD. Variation in market access decisions for cell and gene therapies across the United States, Canada, and Europe. Health Policy 2021; 125:1550-1556. [PMID: 34763929 DOI: 10.1016/j.healthpol.2021.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/13/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022]
Abstract
Transformative cell and gene therapies have now launched worldwide, and many potentially curative cell and gene therapies are in development, offering the prospect of significant health gains for patients. Access to these therapies depend on decisions made by health technology assessment (HTA) and payer organizations. We sought to describe the emerging cell and gene therapies market access landscape by analyzing 17 US commercial payer medical policies, and HTA reports from five European countries and Canada. We found that some US health plans applied coverage restrictions more often than others (four plans applied restrictions in all decisions, while four plans applied restrictions in <30% of decisions). The European and Canadian HTA bodies recommend access to fewer therapies than US health plans, reflecting a more stringent approach in the context of limited evidence and high scientific uncertainty that is commonly associated with these treatments. Our findings suggest that patient access to approved cell and gene therapies is restricted in all regions studied, though the nature of these restrictions differs between US health plans and the European/Canada HTA recommendations. Payers, HTA groups, pharmaceutical companies, and other stakeholders should collaborate to more clearly define the "uncertainties" and develop market access policies that balance benefits of early access with ongoing data collection to close evidence gaps over time.
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Affiliation(s)
| | | | | | | | - Omar Dabbous
- Novartis Gene Therapies, Inc. Bannockburn, IL, USA.
| | | | | | | | | | - Ulf Persson
- IHE - The Swedish Institute for Health Economics, Lund, Sweden
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Silver MC, Neumann PJ, Ma S, Kim DD, Cohen JT, Nyaku M, Roberts C, Sinha A, Ollendorf DA. Frequency and impact of the inclusion of broader measures of value in economic evaluations of vaccines. Vaccine 2021; 39:6727-6734. [PMID: 34656380 DOI: 10.1016/j.vaccine.2021.09.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/25/2021] [Accepted: 09/24/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The health and economic benefits of immunization may extend beyond the elements traditionally included in cost-effectiveness analyses (CEAs). This review investigated how broader impacts are considered in economic evaluations of vaccines and whether their inclusion would substantially change CEA findings. METHODS We reviewed CEAs of vaccines associated with the largest global health burden, published from 2014 to 2019 using the Tufts CEA Registry and Tufts Global Health CEA Registry. We supplemented this with a systematic review of published and grey literature. We conducted descriptive analyses to examine the frequency of inclusion of specific social factors and study characteristics associated with their inclusion. We also conducted a case study of the human papilloma virus (HPV) vaccine to illustrate the potential change in CEA findings from selected social impacts. RESULTS We identified 475 relevant health economic assessments. Overall, 40% of studies included at least one category of social impact. The most commonly included non-healthcare cost among cost-per-QALY studies was productivity (25%), while cost-per-DALY studies reported transportation costs most frequently (24%). Few studies examined the impact of vaccination on other sectors such as education and housing (<3%). Middle-income and North American settings were positively associated with social impact inclusion, while sub-Saharan African location was negatively associated. In the HPV case study, the addition of nonhealth costs improved cost-effectiveness by up to 90% or made the vaccine cost-saving, depending on geographic setting. The cost-saving scenario saved up to $30,000 in costs per case of cervical cancer averted. CONCLUSIONS A minority of vaccine CEAs include social impacts, particularly for nonhealth sectors. The omission of these impacts may result in a systematic undervaluation of vaccines from a societal perspective. Further efforts are required to document the full benefits of vaccination for policymaker consideration.
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Affiliation(s)
- Madison C Silver
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA.
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA
| | - Siyu Ma
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA
| | | | | | | | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, USA
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Kim DD, Do LA, Daly AT, Wong JB, Chambers JD, Ollendorf DA, Neumann PJ. An Evidence Review of Low-Value Care Recommendations: Inconsistency and Lack of Economic Evidence Considered. J Gen Intern Med 2021; 36:3448-3455. [PMID: 33620623 PMCID: PMC8606489 DOI: 10.1007/s11606-021-06639-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/11/2020] [Accepted: 01/25/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Low-value care, typically defined as health services that provide little or no benefit, has potential to cause harm, incur unnecessary costs, and waste limited resources. Although evidence-based guidelines identifying low-value care have increased, the guidelines differ in the type of evidence they cite to support recommendations against its routine use. OBJECTIVE We examined the evidentiary rationale underlying recommendations against low-value interventions. DESIGN We identified 1167 "low-value care" recommendations across five US organizations: the US Preventive Services Task Force (USPSTF), the "Choosing Wisely" Initiative, American College of Physicians (ACP), American College of Cardiology/American Heart Association (ACC/AHA), and American Society of Clinical Oncology (ASCO). For each recommendation, we classified the reported evidentiary rationale into five groups: (1) low economic value; (2) no net clinical benefit; (3) little or no absolute clinical benefit; (4) insufficient evidence; (5) no reason mentioned. We further investigated whether any cited or otherwise available cost-effectiveness evidence was consistent with conventional low economic value benchmarks (e.g., exceeding $100,000 per quality-adjusted life-year). RESULTS Of the identified low-value care recommendations, Choosing Wisely contributed the most (N=582, 50%), followed by ACC/AHA (N=250, 21%). The services deemed "low value" differed substantially across organizations. "No net clinical benefit" (N=428, 37%) and "little or no clinical benefit" (N=296, 25%) were the most commonly reported reasons for classifying an intervention as low value. Consideration of economic value was less frequently reported (N=171, 15%). When relevant cost-effectiveness studies were available, their results were mostly consistent with low-value care recommendations. CONCLUSIONS Our study found that evidentiary rationales for low-value care vary substantially, with most recommendations relying on clinical evidence. Broadening the evidence base to incorporate cost-effectiveness evidence can help refine the definition of "low-value" care to reflect whether an intervention's costs are worth the benefits. Developing a consensus grading structure on the strength and evidentiary rationale may help improve de-implementation efforts for low-value care.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 063, Boston, MA, 02111, USA.
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Lauren A Do
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 063, Boston, MA, 02111, USA
| | - Allan T Daly
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 063, Boston, MA, 02111, USA
| | - John B Wong
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
| | - James D Chambers
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Asukai Y, Briggs A, Garrison LP, Geisler BP, Neumann PJ, Ollendorf DA. Principles of Economic Evaluation in a Pandemic Setting: An Expert Panel Discussion on Value Assessment During the Coronavirus Disease 2019 Pandemic. Pharmacoeconomics 2021; 39:1201-1208. [PMID: 34557996 PMCID: PMC8460393 DOI: 10.1007/s40273-021-01088-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 05/15/2023]
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic continues to generate significant morbidity and mortality as well as economic and societal impacts, the landscape of potential treatments has slowly begun to broaden. In the case of a novel disease with widespread consequences, society is more likely to place significant value on interventions that reduce the outsized economic burden of COVID-19. Treatments for severe disease will have a different value profile to that of large-scale vaccines because of their application in targeted and potentially small subsets of those with symptomatic disease vs broad deployment as a preventative measure. Where vaccines reduce transmissibility of COVID-19, use of therapeutics will target symptoms, up to and including death for infected individuals. This paper describes discussions from a virtual expert panel that met to attempt a consensus on how existing principles of economic evaluation should be applied to therapeutics that emerge in a pandemic setting, with specific focus on severe hospitalised cases of COVID-19. The panel concluded that the core principles of economic evaluation do not need to be drastically overhauled to meet the challenges of a pandemic, but that there are several additional elements of value such as equity, disease severity, insurance value, and scientific and family spillover effects that should be considered when presenting results to decision makers. The panel also highlighted the persistent challenges on how society should value novel therapies, such as the appropriate cost-effectiveness threshold to apply, which are particularly salient during a pandemic.
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Affiliation(s)
- Yumi Asukai
- Value Evidence and Outcomes, GSK, Brentford, England, UK.
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, London, England, UK
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA
| | - Benjamin P Geisler
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University, Munich, Germany
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Neumann PJ. Toward Better Data Dashboards for US Drug Value Assessments. Value Health 2021; 24:1484-1489. [PMID: 34593172 DOI: 10.1016/j.jval.2021.04.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To explore the use of data dashboards to convey information about a drug's value, and reduce the need to collapse dimensions of value to a single measure. METHODS Review of the literature on US Drug Value Assessment Frameworks, and discussion of the value of data dashboards to improve the manner in which information on value is displayed. RESULTS The incremental cost per quality-adjusted life-year ratio is a useful starting point for conversation about a drug's value, but it cannot reflect all of the elements of value about which different audiences care deeply. Data dashboards for drug value assessments can draw from other contexts. Decision makers should be presented with well-designed value dashboards containing various metrics, including conventional cost per quality-adjusted life-year ratios as well as measures of a drug's impact on clinical and patient-centric outcomes, and on budgetary and distributional consequences, to convey a drug's value along different dimensions. CONCLUSIONS The advent of US drug value frameworks in health care has forced a concomitant effort to develop appropriate information displays. Researchers should formally test different formats and elements.
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Affiliation(s)
- Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA, USA.
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Abstract
BACKGROUND Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups. OBJECTIVE The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia. RESEARCH DESIGN This was a prospective cohort study. SUBJECTS A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims. MEASURES We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity. RESULTS A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites. CONCLUSIONS Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Allan T. Daly
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
| | - Joshua T. Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
- Department of Medicine, Tufts University School of Medicine, Boston, MA
| | - Jessica D. Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | | | - Karen M. Freund
- Department of Medicine, Tufts University School of Medicine, Boston, MA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA
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Neumann PJ, Cohen JT, Kim DD, Ollendorf DA. Consideration Of Value-Based Pricing For Treatments And Vaccines Is Important, Even In The COVID-19 Pandemic. Health Aff (Millwood) 2021; 40:53-61. [DOI: 10.1377/hlthaff.2020.01548] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Peter J. Neumann
- Peter J. Neumann is a professor and director of the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, in Boston, Massachusetts
| | - Joshua T. Cohen
- Joshua T. Cohen is a research associate professor at the Center for Evaluation of Value and Risk in Health, Tufts Medical Center
| | - David D. Kim
- David D. Kim is an assistant professor in the Center for Evaluation of Value and Risk in Health, Tufts Medical Center
| | - Daniel A. Ollendorf
- Daniel A. Ollendorf is director of value measurement and global health initiatives, Center for Evaluation of Value and Risk in Health, Tufts Medical Center
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Lin P, Daly A, Olchanski N, Cohen JT, Neumann PJ, Faul JD, Fillit HM, Freund KM. Dementia diagnosis disparities by race and ethnicity. Alzheimers Dement 2020. [DOI: 10.1002/alz.043183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Howard M Fillit
- Geriatric Medicine Palliative Care and Neuroscience The Icahn School of Medicine at Mount Sinai New York NY USA
- Alzheimer’s Drug Discovery Foundation New York NY USA
| | - Karen M Freund
- Tufts Medical Center and Tufts University School of Medicine Boston MA USA
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Kim DD, Silver MC, Kunst N, Cohen JT, Ollendorf DA, Neumann PJ. Correction to: Perspective and Costing in Cost‑Effectiveness Analysis, 1974-2018. Pharmacoeconomics 2020; 38:1377. [PMID: 33089479 PMCID: PMC7661411 DOI: 10.1007/s40273-020-00968-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The article Perspective and Costing in Cost-Effectiveness Analysis.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA.
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Madison C Silver
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
| | - Natalia Kunst
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- LINK Medical Research, Oslo, Norway
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Lin PJ, Cohen JT, Neumann PJ. Preparing the health-care system to pay for new Alzheimer's drugs. Alzheimers Dement 2020; 16:1568-1570. [PMID: 32808733 PMCID: PMC7666042 DOI: 10.1002/alz.12155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 02/04/2023]
Abstract
Biogen's announcement last fall that it will seek U.S. Food and Drug Administration approval for its Alzheimer's disease (AD) treatment, aducanumab, 7 months after the drug was declared a failure, buoyed patients and families, but put health payers and policymakers on alert. Whether aducanumab succeeds, other disease-modifying therapies for AD will follow, and the health-care system is unprepared for the reimbursement and access challenges. Novel AD therapies are much needed, but we cannot assume substantial cost offsets. With forethought and preparation, however, the health-care system can accommodate new AD drugs. First, we urge the use of cost-effectiveness of new Alzheimer's treatments as a starting point for setting value-based prices. Second, payments for new AD therapies should ideally incorporate a performance warranty, which helps apportion risk associated with initial therapy value estimates between drug manufacturers and payers. Third, we urge consideration of "subscription" payment agreements to address system affordability issues.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
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Ma S, Kim DD, Cohen JT, Neumann PJ. Measuring "Fearonomic Effects" in Valuing Therapies: An Application to COVID-19 in China. Value Health 2020; 23:1405-1408. [PMID: 33127009 PMCID: PMC7384788 DOI: 10.1016/j.jval.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To develop a checklist that helps quantify the economic impact associated with fear of contagion and to illustrate how one might use the checklist by presenting a case study featuring China during the coronavirus disease 2019 (COVID-19) outbreak. METHODS Based on "fearonomic effects," a qualitative framework that conceptualizes the direct and indirect economic effects caused by the fear of contagion, we created a checklist to facilitate empirical estimation. As a case study, we first identified relevant sectors affected by China's lockdown policies implemented just before the Lunar New Year (LNY) week. To quantify the immediate impact, we then estimated the projected spending levels in 2020 in the absence of COVID-19 and compared these projections with actual spending during the LNY week. Data sources used include Chinese and global websites. To characterize uncertainty, we reported upper and lower bound estimates and calculated midpoints for each range. RESULTS The COVID-19 epidemic is estimated to cost China's economy $283 billion ($196-369 billion), that is, ¥2.0 trillion renminbi (¥1.4-¥2.6 trillion), during the LNY week. Reduced restaurant and movie theater business ($106 [$103-$109] billion, 37.5% [36.4%-38.5%]) and reduced public transportation utilization ($96 [$13-$179] billion dollars, 33.9% [4.6%-63.3%]) explain most of this loss, followed by travel restrictions and the resulting loss of hotel business and tourism ($80.36 billion, 28.4%). CONCLUSION Our checklist can help quantify the immediate and near-term impact of COVID-19 on a country's economy. It can also help researchers and policy makers consider the broader economic and social consequences when valuing future vaccines and treatments.
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Affiliation(s)
- Siyu Ma
- The Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - David D Kim
- The Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Joshua T Cohen
- The Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- The Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Abstract
OBJECTIVE Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs). METHODS We analyzed the Tufts Medical Center's CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives. RESULTS Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900-110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67-3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017-2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991-49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486-77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective. CONCLUSION Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA.
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
| | - Madison C Silver
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
| | - Natalia Kunst
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
- LINK Medical Research, Oslo, Norway
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Daniel A Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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Kim DD, Ollendorf DA, Neumann PJ, Fendrick AM. Crisis into opportunity: can COVID-19 help set a path to improved health care efficiency? Am J Manag Care 2020; 26:369-370. [PMID: 32930548 DOI: 10.37765/ajmc.2020.88412] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With a "new normal" level of care going forward post coronavirus disease 2019 (COVID-19), the key will be to invest in high-value services while deterring a resurgence of low-value care.
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Affiliation(s)
- David D Kim
- Tufts Medical Center, 800 Washington St, Box 063, Boston, MA 02111.
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Panzer AD, Emerson JG, D'Cruz B, Patel A, Dabak S, Isaranuwatchai W, Teerawattananon Y, Ollendorf DA, Neumann PJ, Kim DD. Growth and capacity for cost-effectiveness analysis in Africa. Health Econ 2020; 29:945-954. [PMID: 32412153 PMCID: PMC7383734 DOI: 10.1002/hec.4029] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/11/2020] [Accepted: 04/14/2020] [Indexed: 05/07/2023]
Abstract
As economic evaluation becomes increasingly essential to support universal health coverage (UHC), we aim to understand the growth, characteristics, and quality of cost-effectiveness analyses (CEA) conducted for Africa and to assess institutional capacity and relationship patterns among authors. We searched the Tufts Medical Center CEA Registries and four databases to identify CEAs for Africa. After extracting relevant information, we examined study characteristics, cost-effectiveness ratios, individual and institutional contribution to the literature, and network dyads at the author, institution, and country levels. The 358 identified CEAs for Africa primarily focused on sub-Saharan Africa (96%) and interventions for communicable diseases (77%). Of 2,121 intervention-specific ratios, 8% were deemed cost-saving, and most evaluated immunizations strategies. As 64% of studies included at least one African author, we observed widespread collaboration among international researchers and institutions. However, only 23% of first authors were affiliated with African institutions. The top producers of CEAs among African institutions are more adherent to methodological and reporting guidelines. Although economic evidence in Africa has grown substantially, the capacity for generating such evidence remains limited. Increasing the ability of regional institutions to produce high-quality evidence and facilitate knowledge transfer among African institutions has the potential to inform prioritization decisions for designing UHC.
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Affiliation(s)
- Ari D. Panzer
- Center for the Evaluation of Value and Risk in HealthTufts Medical CenterBostonMassachusettsUSA
| | - Joanna G. Emerson
- Center for the Evaluation of Value and Risk in HealthTufts Medical CenterBostonMassachusettsUSA
| | - Brittany D'Cruz
- Center for the Evaluation of Value and Risk in HealthTufts Medical CenterBostonMassachusettsUSA
| | - Avnee Patel
- Health Intervention and Technology Assessment Program (HITAP)Ministry of Public HealthNonthaburiThailand
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP)Ministry of Public HealthNonthaburiThailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP)Ministry of Public HealthNonthaburiThailand
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoOntarioCanada
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP)Ministry of Public HealthNonthaburiThailand
- The Saw Swee Hock School of Public HealthNational University of SingaporeSingapore
| | - Daniel A. Ollendorf
- Center for the Evaluation of Value and Risk in HealthTufts Medical CenterBostonMassachusettsUSA
| | - Peter J. Neumann
- Center for the Evaluation of Value and Risk in HealthTufts Medical CenterBostonMassachusettsUSA
| | - David D. Kim
- Center for the Evaluation of Value and Risk in HealthTufts Medical CenterBostonMassachusettsUSA
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Kim DD, Neumann PJ. Analyzing the Cost Effectiveness of Policy Responses for COVID-19: The Importance of Capturing Social Consequences. Med Decis Making 2020; 40:251-253. [PMID: 32428432 DOI: 10.1177/0272989x20922987] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David Daeho Kim
- Tufts Medical Center-Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Peter J Neumann
- Tufts Medical Center-Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
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