Cost effectiveness thresholds: the past, the present and the future

Cost-effectiveness (CE) thresholds are being discussed more frequently and there have been many new developments in this area; however, there is a lack of understanding about what thresholds mean and their implications. This paper provides an overview of the CE threshold literature. First, the meaning of a CE threshold and the key assumptions involved (perfect divisibility, marginal increments in budget, etc.) are highlighted using a hypothetical example, and the use of historic/heuristic estimates of the threshold is noted along with their limitations. Recent endeavours to estimate the empirical value of the thresholds, both from the supply side and the demand side, are then presented. The impact on CE thresholds of future directions for the field, such as thresholds across sectors and the incorporation of multiple criteria beyond quality-adjusted life-years as a measure of ‘value’, are highlighted. Finally, a number of common issues and misconceptions associated with CE thresholds are addressed

Engaging practice nurses in obesity management—a clinical academic partnership to pilot the Counterweight Program

Aims and rationale Developed in the UK, the Counterweight Program offers a structured, evidence‐based model for weight management delivered by practice nurses. The Northern Adelaide Medicare Local (NAML) are concerned about obesity in the region. In a collaboration between researchers and NAML, we are undertaking a pilot study of the Counterweight Program to determine its feasibility and acceptability to Australian general practices and patients. Methods A university‐based researcher and NAML’s Chronic Disease Liaison Officer are leading the day‐to‐day coordination of the pilot study. NAML’s consumer group provided feedback, and practice recruitment was launched at a NAML weight management event. Six nurses from three practices received online training and mentoring from an experienced Counterweight dietitian. Nurses recruited patients and delivered Counterweight over six sessions. Sessions cover healthy lifestyle topics and incorporate behavioural modification techniques. Patient data is being extracted from medical records using an automated tool developed by NAML. Findings Bi‐directional support and collaboration between researchers and NAML has been vital in rolling out the pilot study. The perceived value of upskilling practice nurses to deliver Counterweight is high. To date, practices have been enthusiastic and positive about the online training. Patient recruitment, program delivery and evaluation are ongoing. Relevance to policy, research and/or practice The collaboration has ensured robust research that shares expertise, and fits with the needs of the region and the demands of general practice. The applied collaborative process has helped bridge the gap between

The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals

The healthcare sector in general and hospitals in particular represent a main application area for Data Envelopment Analysis (DEA). This paper reviews 262 papers of DEA applications in healthcare with special focus on hospitals and therefore closes a gap of over ten years that were not covered by existing review articles. Apart from providing descriptive statistics of the papers, we are the first to examine the research purposes of the publications. These research goals can be grouped into four distinct clusters according to our proposed framework. The four clusters are (1) Pure DEA efficiency analysis, i.e. performing a DEA on hospital data, (2) Developments or applications of new methodologies, i.e. applying new DEAy approaches on hospital data, (3) Specific management question, i.e. analyzing the effects of managerial specification, such as ownership, on hospital efficiency, and (4) Surveys on the effects of reforms, i.e. researching the impact of policy making, such as reforms of health systems, on hospital efficiency. Furthermore, we analyze the methodological settings of the studies and describe the applied models. We analyze the chosen inputs and outputs as well as all relevant downstream techniques. A further contribution of this paper is its function as a roadmap to important methodological literature and publications, which provide crucial information on the setup of DEA studies. Thus, this paper should be of assistance to researchers planning to apply DEA in a hospital setting by providing information on a) what has been published between 2005 and 2016, b) possible pitfalls when setting up a DEA analysis, and c) possible ways to apply the DEA analysis in practice. Finally, we discuss what could be done to advance DEA from a scientific tool to an instrument that is actually utilized by managers and policymakers