Health Economics Adam Wagner 14/03/2019 What is the work of - - PowerPoint PPT Presentation

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Health Economics Adam Wagner 14/03/2019 What is the work of - - PowerPoint PPT Presentation

Aug 25, 2022 132 likes •326 views

Collaborations for Leadership In Applied Health Research and Care East of England Health Economics Adam Wagner 14/03/2019 What is the work of health economists ? Addressing infinite health demand with scarce resources: Efficient

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Health Economics

Adam Wagner 14/03/2019 Collaborations for Leadership In Applied Health Research and Care East of England

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What is the work of health economists?

  • Addressing infinite health demand

with scarce resources:

  • Efficient resource allocation
  • Maximise value for money
  • Varied work!
  • Economic evaluations
  • Outcome valuation
  • Providing evidence for policy

Health Economics Theme

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Health Economic (HE) Theme

  • Non-exclusive focus on economic

evaluation (EE)

  • Cross cutting theme:
  • Methodological work:
  • Resource data collection in care homes
  • Replicating decision models
  • Work with other themes:
  • Mindful student study – EE
  • EQUIP trial – EE feasibility
  • CASCADE – HE information

Health Economics Theme

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Background: Economic evaluation

  • Comparing the costs AND benefits of

two or more treatment alternatives

  • Requires:
  • Collection of resource use

→ costs

  • Benefits

→ Often measured in quality adjusted life years (QALYs)

  • Looking for cost-effectiveness

Health Economics Theme

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Health Economic (HE) Theme

  • Non-exclusive focus on economic

evaluation

  • Cross cutting theme:
  • Methodological work:
  • Resource data collection in care homes
  • Replicating decision

models

  • Work with other themes:
  • Mindful student study – EE
  • EQUIP trial – feasibility of EE
  • CASCADE – HE information

Health Economics Theme

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Resource use collection within care home settings (Tracey Sach)

  • Resource use → costs
  • Limited research on methods
  • None in care home setting
  • In CAREMED trial (multi-professional

clinical medication reviews in care homes), a pharmacy tech recorded every visit or contact in:

  • GP electronic records
  • Care home paper records

Health Economics Theme

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Resource use collection within care home settings: Comparison+Impacts

  • Significantly different overall mean

contacts (95% CI: 2.1, 5.0) & costs (CI: 74, 206) → Impact on conclusions!

  • Very limited agreement:
  • Biggest dif.: district nurse
  • Care home more complete?
  • Most impactful resources: GP;

district nurses; specialist nurse

Data source GP Care home Mean overall contacts 12.5 16.0 Mean overall cost £625 £765 Mean GP visits 7.1 5.8 Mean GP costs £306 £251 Mean district nurse visits 3.1 6.3 Mean district nurse costs £130 £262

Health Economics Theme

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Health Economic (HE) Theme

  • Non-exclusive focus on economic

evaluation

  • Cross cutting theme:
  • Methodological work:
  • Resource data collection in care homes
  • Replicating decision models
  • Work with other themes:
  • Mindful student study – EE
  • EQUIP trial – feasibility of EE
  • CASCADE – HE information

Health Economics Theme

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Replicability of decision models: Background

  • Scientific principle: Replicability
  • Decision models: key EE tool
  • Rarely replicate models;
  • Not thought practical at ISPOR
  • Importance:
  • Models inform funding
  • Greater model clarity →

promotes understanding

  • Defend against manipulation
  • Check for errors!

Dean et al. (2001)

Health Economics Theme

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Replicability of decision models: Method & results

  • 5 models from literature in different

clinical conditions

  • 5 different modellers (of varying

experience) try to replicate each model & related results

  • Difficult!
  • See McManus et al.!

(under review)

  • Health Economics Theme
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Health Economic (HE) Theme

  • Non-exclusive focus on economic

evaluation (EE)

  • Cross cutting theme:
  • Methodological work:
  • Resource data collection in care homes
  • Replicating decision

models

  • Work with other themes:
  • Mindful student study – EE
  • EQUIP trial – EE feasibility
  • CASCADE – HE information

Health Economics Theme

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Mindful student study (Julieta Galante & Peter Jones)

  • 2 arm trial investigating if mindfulness

increases resilience among university students

  • It does! Galante et al. (2017)
  • Economic evaluation:

How do the additional costs and benefits to the university counselling service of delivering mindfulness (mental health scores/QALYs) compare to current services? <analysis underway>

Health Economics Theme

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Health Economic (HE) Theme

  • Non-exclusive focus on economic

evaluation (EE)

  • Cross cutting theme:
  • Methodological work:
  • Resource data collection in care homes
  • Replicating decision

models

  • Working with other themes:
  • Mindful student study – EE
  • EQUIP trial – EE feasibility
  • CASCADE – HE information

Health Economics Theme

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EQUIP Feasibility trial (Economics): Garry Barton

  • Adults with intellectual

developmental disabilities (IDD) detained in secure units & history

  • f criminal behaviour
  • Economic evaluation feasibility:
  • Resource use collectable?
  • Quality of life (EQ-5D) collectable?
  • Analysis:
  • Completion rates
  • Identify large cost drivers
  • Prelimin. cost effectiveness

Health Economics Theme

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Health Economic (HE) Theme

  • Non-exclusive focus on economic

evaluation (EE)

  • Cross cutting theme:
  • Methodological work:
  • Resource data collection in care homes
  • Replicating decision

models

  • Work with other themes:
  • Mindful student study – EE
  • EQUIP trial – EE feasibility
  • CASCADE – HE info

Health Economics Theme

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CASCADE – dementia case finding (Frances Bunn)

  • Dementia case finding:

memory assessment of 75+ admitted unexpectedly

  • Delivery approach?

Impact?

  • HE explored:
  • Costs of case finding
  • Quality of life of identified cases
  • Impact on services

Health Economics Theme

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Health economics: Going forward

  • Evidence to inform

implementation decisions

  • Application and extension of

measurement & valuation methods

  • Economic evaluation
  • ‘Holistic’ benefits: patient-centred
  • utcomes
  • Social AND health outcomes
  • Public prioritisation preferences

for health and social care

Health Economics Theme

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Questions?

adam.wagner@uea.ac.uk

HE theme: Garry Barton, Christina-Jane Crossman-Barnes Lisa Irvine, David Turner, Emma McManus, Tracey Sach, Angela Robinson, Chris Skedgel, Adam Wagner, Jenny Whitty McManus, E., Turner, D., Gray, E., Khawar, H., Okoli, T., Sach. T. (under review). The Barriers and Facilitators to Model Replication within Health Economics. Sach, T., Desborough, J., Houghton, J. & Holland, R. (2018). “A comparison of two sources of primary and social care resource use data in a care home setting” In Unit Costs of Health and Social Care 2018, edited by Curtis, L. & Burns, A. Kent, Canterbury: PSSRU, University of Kent. https://www.pssru.ac.uk/pub/uc/uc2018/sach.pdf

Health Economics Theme