Unbiased Analysis of Today's Healthcare Issues
That is the questions Peter Neumann and David Kim (2023) answer in their JAMA research letter published today. They use 1990-2021 data from the Tufts Medical Center CEA Registry. The results are summarized in the graphs below. First, we see the use of a explicit cost effectiveness threshold increasing over time, from only 45% of…
Both the Inflation Reduction Act and Affordable Care Act contained language that made cost-effectiveness analysis difficult to implement, while allowing for the analysis of comparative effectiveness with respect to the relative health benefits across treatments. This leads to the natural question, how often are would reimbursement decisions based on comparative effectiveness alone be the same…
In recent years, policymakers and payers have been focused increasingly not only on how new health technologies improve overall health, but also whether they can reduce health disparities. Oftentimes, however, discussions around health disparities are conducted on a qualitative basis with litlted quantitative analysis of tradeoffs between equity and effectiveness. Distributional cost effectiveness analysis (DCEA)…
How do you measure changes in quality of life for patients with cancer? Today we will review 3 different approaches: health state based, health state with age decrements, and health state with time-to-death (TTD) decrements. Health state based. One common approach is just to use the quality of life of a given health state. For…
If you were a drug manufacturer, you naturally would want to focus your research on more common, highly prevalent diseases. If there are more patients with the disease, that means more drugs that can be sold. In recent years, however, the number of so-called “orphan drugs” has increased. In the 1970s, only 10 orphan drugs…
In the United Kingdom, the National Institute for Health and Care Excellence (NICE) made an update to their health technology evaluations manual in January 2022. Of particular interest, section 6.2 of the manual states that the review committee “will consider the associated absolute and proportional QALY shortfall.” The committee defined QALY shortfall two ways: Absolute…
Standard quality approach compares the difference in QALYs which is a function of survival and quality of life during each survival period. Consider the comparison of treatments A and B, where treatment A is the novel treatment and treatment B is the standard of care. Under the QALY based approach this is calculated as Where…
That is a title of a new white paper from FTI Consulting and Alexion. The key findings from the article are: HTA practices are designed to be used for medical technologies and pharmaceuticals that treat commonly-occurring diseases, and are not fit to determine the value of orphan drugs for rare disease, which face unique challenges.…
A paper by Rand and Kesselheim (2021) in Health Affairs this month conducts a systematic literature review to answer this question. Based on 113 articles they identified in peer-reviewed journals, they identify the following 10 criticisms categories. The graph above has each criticism category and the number of peer-reviewed articles that mention this critique type.…
That is the question that a recent study by Tisdale et al. (2021) aim to answer. They first look at the top 250 Medicare Part D drugs in terms 2016 total spending based on the 2016 Medicare Part D Prescriber Public Use File. Drug characteristics were identified from the 2016 FDA Orange Book. The authors…