Avoiding Opportunity Cost Neglect in Cost-Effectiveness Analysis for Health Technology Assessment.


Journal

Applied health economics and health policy
ISSN: 1179-1896
Titre abrégé: Appl Health Econ Health Policy
Pays: New Zealand
ID NLM: 101150314

Informations de publication

Date de publication:
01 2022
Historique:
accepted: 01 08 2021
pubmed: 2 9 2021
medline: 1 2 2022
entrez: 1 9 2021
Statut: ppublish

Résumé

Despite being a fundamental tenet of economic analysis there is a lack of clarity regarding the relevance of opportunity costs to cost-effectiveness analysis for health technology assessment. We argue that this is due, in part, to the importance of the decision context in understanding the nature of opportunity costs. Taking the example of the National Institute of Health and Care Excellence (NICE) on behalf of the National Health Service (NHS) in England and Wales, we explore the implications of existing discrepancies between policy thresholds and emerging empirical evidence of health opportunity costs. In particular, we consider analysts communicating the results of cost-effectiveness analysis, and recommend that analysts provide analysis according to both the policy threshold and the latest empirical evidence until the discrepancies are better understood or resolved. A number of conceptually related, but distinct, issues are discussed and clarified.

Identifiants

pubmed: 34467474
doi: 10.1007/s40258-021-00679-9
pii: 10.1007/s40258-021-00679-9
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

13-18

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Références

Modig N. What do economic scholars consider powerful economic knowledge of importance for people in their private and public lives? Implications for teaching and learning economics in social studies. Stud High Educ [Internet]. 2020. https://doi.org/10.1080/03075079.2020.1716319 .
doi: 10.1080/03075079.2020.1716319
Culyer AJ. Cost, context, and decisions in health economics and health technology assessment. Int J Technol Assess Health Care [Internet]. 2018;34(5):434–41. https://www.cambridge.org/core/product/identifier/S0266462318000612/type/journal_article . Accessed 18 Jun 2019.
Palmer S, Raftery J. Opportunity cost. BMJ [Internet]. 1999;318(7197):1551. https://www.bmj.com/content/318/7197/1551 . Accessed 9 Dec 2020.
Ferraro PJ, Taylor LO. Do economists recognize an opportunity cost when they see one? A dismal performance from the dismal science. Contrib Econ Anal Policy [Internet]. 2005;4(1):1–12. Available from: https://www.degruyter.com/view/journals/bejeap/4/1/article-p1.xml . Accessed 9 Dec 2020.
Potter J, Sanders S. Do economists recognize an opportunity cost when they see one? A dismal performance or an arbitrary concept? South Econ J Internet. 2012;79(2):248–56. https://doi.org/10.4284/0038-4038-2011.218 .
doi: 10.4284/0038-4038-2011.218
Persson E, Tinghög G. Opportunity cost neglect in public policy. J Econ Behav Organ. 2020;1(170):301–12.
doi: 10.1016/j.jebo.2019.12.012
Claxton K, Sculpher M, Palmer S, Culyer AJ. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients? Health Econ Internet. 2015;24(1):1–7.
doi: 10.1002/hec.3130
Appleby J, Devlin N, Parkin D, Buxton M, Chalkidou K. Searching for cost effectiveness thresholds in the NHS. Health Policy (New York) [Internet]. 2009;91(3):239–45.
Claxton K, Martin S, Soares M, Rice N, Spackman E, Hinde S, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015;19(14):1–503, v-vi. https://doi.org/10.3310/hta19140 .
Schaffer SK, Cubi-Molla P, Devlin N, Towse A. Shaping the Research Agenda to Estimate Relevant Cost- effectiveness Thresholds for Health Technology Assessment Decision Making: Report for ABPI. 2016. https://www.ohe.org/system/files/private/publications/Shaping%20the%20research%20agenda%20to%20estimate%20costeffectiveness%20thresholds%20FOR%20PUBLICATION.pdf . Accessed 16 May 2017.
Martin S, Rice N, Smith PC. Does health care spending improve health outcomes? Evidence from English programme budgeting data. J Health Econ [Internet]. 2008;27(4):826–42.
doi: 10.1016/j.jhealeco.2007.12.002
Martin S, Rice N, Smith PC. Comparing costs and outcomes across programmes of health care. Health Econ [Internet]. 2012;21(3):316–37.
doi: 10.1002/hec.1716
Drummond M, Sculpher M, Claxton K, Stoddart G, Torrance G. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2015.
Walker S, Griffin S, Asaria M, Tsuchiya A, Sculpher M. Striving for a societal perspective: a framework for economic evaluations when costs and effects fall on multiple sectors and decision makers. Appl Health Econ Health Policy [Internet]. 2019; 17: 577–590.
DHSC. Voluntary scheme for branded medicines pricing and access: heads of agreement [Internet]. 2018. https://www.gov.uk/government/publications/voluntary-scheme-for-branded-medicines-pricing-and-access-heads-of-agreement/voluntary-scheme-for-branded-medicines-pricing-and-access-heads-of-agreement . Accessed 16 Dec 2020.
NICE. Guide to the methods of technology appraisal. 2013. https://www.nice.org.uk/process/pmg9/chapter/foreword . Accessed 31 Jul 2017.
Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgments. BMJ [Internet]. 2004;329(7459):224–7. http://www.bmj.com/content/329/7459/224 . Accessed 29 Nov 2015.
Williams A. What Could be Nicer than NICE? [Internet]. OHE Annual Lecture. 2004. https://www.ohe.org/publications/what-could-be-nicer-nice . Accessed 12 Aug 2019.
Committee H of CH. NICE: First report of the Health Committee 2007-2008. Stationery Office; 2008.
Committee H of CH. The government’s response to the Health Select Committee’s first report of session 2007-08 on the National Institute for Health and Clinical Excellence. Cm7331. Stationery Office; 2008.
Committee H of CH. NICE response to the first report of session 2007-2008. HC550. Stationery Office; 2008.
DHSC. Accelerated Access Collaborative for health technologies DH Impact Assessment [Internet]. 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/663094/Accelerated_Access_Collaborative_-_impact_asssessment.pdf . Accessed 22 Jun 2021.
DHSC. 2018 Statutory Scheme-Branded Medicines Pricing IA [Internet]. 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/761064/impact-assessment-2018-statutory-scheme-branded-medicines-pricing.pdf . Accessed 22 Jun 2021.
DHSC. NICE’s technology appraisal and highly specialised technology work programmes-charging and Appeals Panels Impact Assessment (IA) [Internet]. 2018. https://www.legislation.gov.uk/ukia/2018/171/pdfs/ukia_20180171_en.pdf . Accessed 22 Jun 2021.
Edney LC, Ali Afzali H, Cheng TC, Karnon J. Estimating the reference incremental cost-effectiveness ratio for the Australian health system. Pharmacoeconomics [Internet]. 2018;36(2):239–52.
doi: 10.1007/s40273-017-0585-2
Vallejo-Torres L, García-Lorenzo B, Serrano-Aguilar P. Estimating a cost-effectiveness threshold for the Spanish NHS. Health Econ [Internet]. 2018;27(4):746–61. https://doi.org/10.1002/hec.3633 .
doi: 10.1002/hec.3633 pubmed: 29282798
Siverskog J, Henriksson M. On the role of cost-effectiveness thresholds in healthcare priority setting [Internet]. Int J Technol Assess Health Care. 2021;37:e23.
Hunter D. Desperately seeking solutions: rationing health care. London: Routledge; 1998.
Faria R, Ochalek J, Lomas J. Opportunity costs, marginal productivity, and cost-effectiveness thresholds: providing useful analysis and communicating results [Internet]. 2020. https://aheblog.com/2020/09/24/opportunity-costs-marginal-productivity-and-cost-effectiveness-thresholds-providing-useful-analysis-and-communicating-results/ . Accessed 16 Dec 2020.
Basu A. A welfare-theoretic model consistent with the practice of cost-effectiveness analysis and its implications. J Health Econ. 2020;70:102287.
doi: 10.1016/j.jhealeco.2020.102287
Phelps CE. A new method to determine the optimal willingness to pay in cost-effectiveness analysis. Value Heal [Internet]. 2019;22(7):785–91.
doi: 10.1016/j.jval.2019.03.003
Vallejo-Torres L, García-Lorenzo B, Castilla I, Valcárcel-Nazco C, García-Pérez L, Linertová R, et al. On the estimation of the cost-effectiveness threshold: why, what, how? Value Heal [Internet]. 2016;19(5):558–66.
doi: 10.1016/j.jval.2016.02.020
Brouwer W, van Baal P, van Exel J, Versteegh M. When is it too expensive? Cost-effectiveness thresholds and health care decision-making. Eur J Heal Econ [Internet]. 2018. https://doi.org/10.1007/s10198-018-1000-4 .
doi: 10.1007/s10198-018-1000-4
Claxton K, Asaria M, Chansa C, Jamison J, Lomas J, Ochalek J, et al. Accounting for timing when assessing health-related policies. J Benefit-Cost Anal. 2019.
Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG. Willingness to pay for a quality-adjusted life year: In search of a standard. Med Decis Mak [Internet]. 2000;20(3):332–42. https://doi.org/10.1177/0272989X0002000310 .
doi: 10.1177/0272989X0002000310
Mishan EJ. Consistency in the valuation of life: a wild goose chase? Soc Philos Policy [Internet]. 1985;2(2):152–67. https://www.cambridge.org/core/journals/social-philosophy-and-policy/article/abs/consistency-in-the-valuation-of-life-a-wild-goose-chase/5CEA76C10C202E8BB19C80B758C60970 . Accessed 9 Apr 2021.
Baker R, Bateman I, Donaldson C, Jones-Lee M, Lancsar E, Loomes G, et al. Health Technology Assessment NIHR HTA programme www.hta.ac.uk Weighting and valuing quality-adjusted life-years using stated preference methods: preliminary results from the Social Value of a QALY Project. Health Technol Assess (Rockv) [Internet]. 2010;14(27). www.hta.ac.uk . Accessed 9 Apr 2021.
Himmler S, van Exel J, Brouwer W. Estimating the monetary value of health and capability well-being applying the well-being valuation approach. Eur J Heal Econ [Internet]. 2020;21(8):1235–44. https://doi.org/10.1007/s10198-020-01231-7 .
doi: 10.1007/s10198-020-01231-7
van Baal P, Perry-Duxbury M, Bakx P, Versteegh M, van Doorslaer E, Brouwer W. A cost-effectiveness threshold based on the marginal returns of cardiovascular hospital spending. Health Econ [Internet]. 2019;28(1):87–100. https://doi.org/10.1002/hec.3831 .
doi: 10.1002/hec.3831 pubmed: 30273967
Treasury H. The Green Book Central Government Guidance On Appraisal And Evaluation 2020 [Internet]. 2018. www.gov.uk/official-documents . Accessed 9 Apr 2021.
Lomas J, Martin S, Claxton K. Estimating the Marginal Productivity of the English National Health Service From 2003 to 2012. Value Heal. 2019;22(9): 995–1002.
DHSC. Cost-effectiveness methodology for Immunisation Programmes and Procurements (CEMIPP) The government’s decision and summary of consultation responses [Internet]. 2019. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/707847/c . Accessed 28 Dec 2020.
Finkelstein A, Hendren N. Welfare analysis meets causal inference. J Econ Perspect [Internet]. 2020;34(4):146–67. https://doi.org/10.1257/jep.34.4.146 .
doi: 10.1257/jep.34.4.146
NICE. Reviewing our methods for health technology evaluation: consultation [Internet]. 2020. https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/chte-methods-consultation . Accessed 16 Dec 2020.
Asaria M, Griffin S, Cookson R. Distributional cost-effectiveness analysis: a tutorial. Med Decis Making. 2015. 36(1):8–19. https://doi.org/10.1177/0272989X15583266 .
Paulden M, McCabe C. Modifying NICE’s Approach to Equity Weighting. Pharmacoeconomics [Internet]. 2021; 39(2):147–160. https://doi.org/10.1007/s40273-020-00988-2 .
Cubi-Molla P, Buxton M, Devlin N. Allocating public spending efficiently: is there a need for a better mechanism to inform decisions in the UK and elsewhere? Appl Heal Econ Heal Policy 2021 [Internet]. 2021. https://doi.org/10.1007/s40258-021-00648-2 .
doi: 10.1007/s40258-021-00648-2
Griffin S, Walker S, Sculpher M. Distributional cost effectiveness analysis of West Yorkshire low emission zone policies. Health Econ [Internet]. 2020;29(5):567–79. https://doi.org/10.1002/hec.4003 .
doi: 10.1002/hec.4003 pubmed: 32003147
Ramponi F, Walker S, Griffin S, Parrott S, Drummond C, Deluca P, et al. Cost-effectiveness analysis of public health interventions with impacts on health and criminal justice: an applied cross-sectoral analysis of an alcohol misuse intervention. Health Econ [Internet]. 2021. https://doi.org/10.1002/hec.4229 .
doi: 10.1002/hec.4229 pubmed: 33604984
Sculpher M, Claxton K, Pearson SD. Developing a value framework: the need to reflect the opportunity costs of funding decisions. Value Heal [Internet]. 2017;20(2):234–9.
doi: 10.1016/j.jval.2016.11.021
Ochalek J, Revill P, Manthalu G, McGuire F, Nkhoma D, Rollinger A, et al. Supporting the development of a health benefits package in Malawi. BMJ Glob Heal [Internet]. 2018;3(2):607. https://doi.org/10.1136/bmjgh-2017-000607 .
doi: 10.1136/bmjgh-2017-000607
van Baal P, Morton A, Severens JL. Health care input constraints and cost effectiveness analysis decision rules. Soc Sci Med. 2018;1(200):59–64.
doi: 10.1016/j.socscimed.2018.01.026
Vanness DJ, Lomas J, Ahn H. A health opportunity cost threshold for cost-effectiveness analysis in the United States. Ann Intern Med [Internet]. 2020. https://doi.org/10.7326/M20-1392 .
doi: 10.7326/M20-1392 pubmed: 33136426

Auteurs

James Lomas (J)

Centre for Health Economics, University of York, York, UK. james.lomas@york.ac.uk.

Jessica Ochalek (J)

Centre for Health Economics, University of York, York, UK.

Rita Faria (R)

Centre for Health Economics, University of York, York, UK.

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