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| Mike Saks and Judith Allsop |
Chapter 14 - The Use of Economics
in Health Research
Alan Maynard |
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| Contributor
biography |
| Alan Maynard is Professor of Health
Economics at the University of York, UK and was the founding
director of the University’s Centre for Health Economics
(1983-1995) and Secretary of the Nuffield Provincial Hospitals
Trust (1995-6). He has a number of visiting professorships
including the London School of Economics and is a Visiting
Professorial Fellow at the King’s Fund Institute.
He has written extensively on health economics and economic
aspects of health policy. |
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| Chapter overview |
| This chapter considers the rationale
for economic evaluation. It outlines the different types
of economic evaluation and discusses the techniques for
economic evaluation in treatment prioritization. |
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| Chapter links |
| Chapter
19 - Involving the Consumer in Health Research |
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| Suggested
Online Readings |
| Ashley,
A., Lloyd, A., Lamb, S. and Bartlett, H. (2001) ‘Is
Health-related Quality of Life a Suitable Outcome Measure
for Evaluating Health Promotion Programmes?’, Journal
of Research in Nursing, 6 (3): 671-78. |
| This study describes results from
a double-blind randomised controlled trial which examined
the efficacy of a primary care-based exercise promotion
programme (the Health Walks Scheme). Quality of life data
from the SF-36 questionnaire are presented from 260 previously
sedentary participants randomly selected from a large
GP practice. After 12 months, only 61 percent of participants
in the health walks group were still classified as sedentary,
compared with 73 percent in the control group who were
simply given advice regarding exercise. The appropriateness
of quality of life outcome measures in health promotion
trials is discussed in the light of the findings. |
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| Drummond,
M. F., Barbieri, M. and Wong, J.B. (2005) ‘Analytic
Choices in Economic Models of Treatments for Rheumatoid
Arthritis: What Makes a Difference?’, Medical
Decision Making, 25 ( 5): 520-33. |
| This paper compares the analytic judgments,
data, and assumptions of different models used in the
economic evaluation of infliximab, one of a new class
of drugs for rheumatoid arthritis (RA). A detailed assessment
was made of four models, one submitted (in a reimbursement
dossier) by the manufacturer, one produced by an independent
academic group and two recently published in the literature.
Factors considered included the key data inputs, assumptions
about the sequencing of treatments for RA, the methods
used to calculate health utilities, and the estimation
of cost offsets. Two of the four models, although embodying
different methodological approaches, gave fairly similar
results. The other two models, both by an independent
academic group, gave much higher estimates per additional
QALY. The differences appeared to depend mainly on differences
in model structure, the assumptions about the positioning
of infliximab in the treatment sequence, and the relationship
between Health Assessment Questionnaire (HAQ) states and
QALYs. |
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| Monninkhofe,
E., Van der valk, P., Schermer, T.,Van der palen, J.,
Van herwaarden, C. and Zielhuis, G. (2004) ‘Economic
Evaluation of a Comprehensive Self-Management Programme
in Patients with Moderate to Severe Chronic Obstructive
Pulmonary Disease’, Chronic Respiratory Disease,
1 (1): 7-16. |
| This paper investigates whether a
comprehensive self-management programme, including self-treatment
guidelines for an exacerbation of a condition and a fitness
programme, is an efficient treatment option for chronic
obstructive pulmonary disease (COPD) patients. 248 COPD
patients were randomly allocated to either self-management
(127) or usual care (121). Data on preference-based utilities
(EuroQol-5D): health-related quality of life (HRQoL):
health-care resource use and productivity losses associated
with exacerbations were prospectively collected. Quality-adjusted
life years (QALYs) were calculated. The economic analysis
took the societal perspective and the observation period
was one year. Because the groups were equally effective
in terms of QALYs and HRQoL (SGRQ): a cost minimization
analysis is provided. Concludes that the COPE self-management
programme is not an effective treatment option for moderate
to severe COPD patients who rate their HRQoL relatively
high. |
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| Further Reading |
| Drummond, M., Sculpher, M.J., Torrance,
G.W., O’Brien, B. and Stoddart, G.L. (2005) Methods
of Economic Evaluation of Health Care Programmes. 3rd
edition. Oxford: Oxford University Press. |
| This book is an essential guidebook
for practitioners on the issues raised in this chapter. |
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| Jefferson, T., Demicheli, V. and Mugford,
A. (2000) Elementary Evaluation in Health Care.
Oxford: Oxford University Press. |
| This is more of an elementary and
introductory guide to the use of economics in health research. |
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© Sage Publications Ltd. |
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