Unbiased Analysis of Today's Healthcare Issues
Cost effectiveness research aims to determine if the benefits of a treatment outweigh the cost. But which benefits should be included? How should we weight improvements in different outcomes? What data and methods need to be used to measure benefits and costs? These are questions that academics typically think of as within the domain of…
How do you do cost effectiveness the right way? Peter Neumann–a colleague of mine at Precision Health Economics–edits a book to explain how to do just that. Neumann and Gillian D. Sanders, Louise B. Russell, Joanna E. Siegel, and Theodore G. Ganiats have produced a second edition of their classic text Cost-Effectiveness in Health and Medicine. The…
Health technology assessments (HTAs) aim to measure the cost effectiveness of a given treatment or set of treatments for a specific patient populations. Often, these assessments are conducted from the point of view of the payer–either a national health system or the individual insurer perspective. This payer focused perspective can often focus largely on treatment costs rather…
Should instrumental variables (IV) be used for real-world evaluation of the comparative effectiveness of different studies? It depends on who you ask.Garabedian et al. (2014) state Although no observational method can completely eliminate confounding, we recommend against treating instrumental variable analysis as a solution to the inherent biases in observational CER studies. On the other hand, Glymour,…
How do you implement a cost effectiveness analysis (CEA) for the implementation of evidence-based practices (EBP)? This is the topic Fortney et al. (2014) address. They review four types of CEAs. Trial based CEA. Relies on traditional randomized controlled trials (RCT). Because RCTs are expensive, they are typically run on a small sample of the…
Both the stimulus bill (i.e., The American Recovery and Reinvestment Act of 2009 [ARRA]) and Obamacare (the Affordable Care Act [ACA]) contain provisions to increase funding for compariative effectiveness research (CER). According to a Deloitte Issue Brief, ARRA provided the foundation for the ACA’s newly mandated and immediately effective CER entity, the Patient-Centered Outcomes Research Institute…
In the past decades, many surgeries have gone from a standard, open surgical approach to a minimally invasive one using laproscopic, endoscopic, and catheter based techniques. What has been the effect of these innovations on medical spending and employee absenteeism? To answer this question, a paper by Epstein et al. (2013) examines a sample of…
Comparative Effectiveness Research (CER) aims to determine whether a drug or medical procedure’s are more cost-effective than alternative treatments and/or none at all. Although the U.S. is not known as a leader in CER research (in part because public health insurance bodies such as Medicare do not take CER evidence into account when making coverage…
Many of the best practices discovered in the research community are never implemented in practice. Why is this the case? One reason is that physicians are overloaded with information and it is costly to cull the literature for best practice information. This is especially true when best practices are not clearly identified or change over…
To what standard should the FDA hold new drugs? The FDA has a number of choices. Drugs companies could be required to prove that the drugs they make: Do no harm. Are more effective than placebos Are more effective than existing drugs Are more cost-effective than existing drugs, or Are both more effective and more…