MedicalResearch.com Interview with:
Gillian D. Sanders-Schmidler Ph.D.
Professor of Medicine
Duke Evidence Synthesis Group, Director
Duke Evidence-based Practice Center, Director
Duke Clinical Research Institute
MedicalResearch.com: What is the background for this study?
Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations.
This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers.
MedicalResearch.com: What are the main recommendations?
Response: The main recommendations are:
• Broadening the scope of the Reference Cases, which describe standard methodology that should be followed to ensure quality analysis by creating comparable measurements.
• Measuring health effects in terms of quality-adjusted life years, a measure that includes both the quality and quantity of life lived.
• Including both costs reimbursed by third-party payers and those paid for out-of-pocket by patients in healthcare sector analyses.
• Using an “Impact Inventory” that lists the health and non-health effects of a healthcare intervention to ensure that all consequences are considered, including those to patients, caregivers, social services and others outside the healthcare sector. This tool also allows analysts to look at categories of impacts that may be most important to stakeholders.
• A reporting checklist and guidelines for transparency that includes assumptions in any analysis and the disclosure of potential conflicts of interest.
MedicalResearch.com: What should readers take away from your report?
Response: The goal of cost-effectiveness analysis is to get as much health from our healthcare dollars as possible. Unfortunately, the U.S. does a poor job of meeting that goal: Americans live shorter lives than people in nearly every other high-income country in the world even though the U.S. spends more than any other country in the world on medical care – 18 cents of every dollar of national income, compared with 12 cents or less for other high-income countries. Everyone who cares about good health and improving health in the U.S. should care about these recommendations.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Although this paper provides an update on the recommendations for cost effectiveness analysis there is a lot of work that still needs to be done – both in terms of the underlying methods and than in the implementation of these analyses into clinical practice and policy.
Some of the key areas needing additional research include:
• The use of multicriteria decision analysis and group decision making,
• The use of CEA in value-based pricing
• Estimation of cost-effectiveness thresholds
• The link between CEA and incentives for innovation
• The role of CEA within health plans or guideline development, and
• The effect of the two recommended Reference Case perspectives on analyses and their findings.
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