Unbiased Analysis of Today's Healthcare Issues
A Health Affairs Forefront paper by researchers Melanie Whittington, Peter Neumann, Joshua Cohen, and Jonathan Campbell makes a compelling case for incorporating drug price dynamics into cost effectiveness analysis. The first questions many people may have is ‘how do drug prices usually change over time?’ A drug’s net price often increases following launch and may…
A recent paper by Ben et al. (2023) provides an R tutorial for implementing economic evaluations–often cost effectiveness analyses–using data from clinical trials and analyzed using R. The article starts by providing a summaries of key issues researchers face when conducting these economic evaluations: Missing values. Missing data are common in clinical trials either due…
On September 25, ICER released its 2023 value assessment framework. What is new? What stays the same? Here are a few key points you need to know. Special cases for ultra-rare and single or short-term therapies (SST): These did not change from previous. Adaptations for ultra-rare disease (from Jan 2020) Single or short-term therapies (from…
One concern when using quality adjusted life years (QALY) to measure health gains for cost effectiveness research is that QALYs “undervalue” health gains from life extension for people with serious illness or chronic disability. To see this clearly, take a look at the QALY formula (first formula below) and how it can be decomposed into…
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…