Deploying a spreadsheet tool for early economic value assessment of medical device innovations with healthcare decision makers

Early stage evaluation of medical device innovations is important for healthcare decision-makers as much as for manufacturers, meaning that a wider application of a basic cost-effectiveness analysis is becoming necessary outside the usual expert base of health technology assessment specialists. Resulting from an academic-industry-healthcare professional collaboration, a spreadsheet tool is described that was designed to be accessible both to professionals in healthcare delivery organisations and to innovators in the healthcare technology industry who are non-experts in the field of health economics. The tool enables a basic cost-effectiveness analysis to be carried out, using a simplified decision-tree model to compare costs and patient benefit for a new device-related procedure with that of standard care employing an incumbent device or other alternative. Such a tool is useful to healthcare professionals because it enables them to rapidly elucidate the cost-effectiveness of heterogeneous innovations by means of the standard quality adjusted life year (QALY) measure of clinical outcome, which is intended to be broadly comparable across treatments. For the innovator or manufacturer it helps them focus on what is required for future stages of development, in order to fill gaps in the input data and so further strengthen their case from a health economics perspective. Results are presented of first experiences from deploying the tool on three medical device exemplars, in face-to-face meetings of the NHS National Innovation Centre (NIC) along with the innovator or clinical champion. The results show that mapping of device-related innovations to the tool is achievable in a short meeting between the NIC and the innovator using expected costs, outcomes data from the literature and estimates of ranges for unknown input data. Whilst the result of a simplified analysis is not expected to be definitive, the process of reasoning is found to be illuminating for the parties involved, enabling innovators to articulate the benefits of their innovations and for all parties to highlight gaps in data and evidence that will be required to take the innovation forward. The partnership model of the authors’ organisation supports the kind of cooperative design approach that is necessary to produce the kind of tool described.---------------------------7dd39101208fa Content-Disposition: form-data; name="c14_creators_1_name_family" Crave

Lender Liability: Civil Liability Regimes For Environmental Harm

Lenders in the 1990s are increasingly being forced to take notice of environmental risks in their lending practices in both the United States and abroad

An economic evaluation of the osmoregulation gene technology to the Australian wheat industry

Episodes of rainfall irregularity and soil moisture deficit have focused attention on the widespread limitation of water supply on winter cereal crop production in Australia. This has motivated a number of efforts at breeding for improved drought tolerance. A recent example involves a cellular adaptation which mitigates water loss through solute accumulation (osmoregulation or osmotic adjustment). An assessment of the performance of osmoregulation yield response in the presence of climate change found that wheat cultivars with this gene are unlikely to be adversely affected by hotter and drier conditions across the wheat belt. The results of an economic evaluation of potential future innovations (wheat cultivars) from the osmoregulation gene technology are that for Australia the net present value could range from $388 million to$3.6 billion, depending on the adoption of wheat cultivars with the gene. Associated benefit-cost ratios ranged from 43:1 to 390:1, and internal rates of return were 16% to 27%. Even under pessimistic assumptions the returns are quite healthy. For NSW-only adoption, internal rates of return ranged from 10% to 22%. This osmoregulation technology has the potential for inclusion in wheat cultivars bred for other purposes, and for other crops. As such it has implications for agricultural plant breeders and farmers both in Australia and overseas, and there are substantial potential spillover benefits.economic evaluation, wheat breeding, osmoregulation, Crop Production/Industries, Research Methods/ Statistical Methods,

State Aid to Public Schools: An Analysis of State Responsiveness to School District Needs

Despite decades of attempted fiscal reforms throughout virtually every state, most state school aid is still allocated on a per pupil basis. The chance exists, nonetheless, that the remaining funds are at least somewhat targeted to socioeconomic or fiscal need. This research, covering two recent time periods, finds little evidence that non-enrollment-based state aid is targeted to need

Capital Budgeting for Small Businesses: An Appropriate Modification of Net Present Value

This paper sets forth a capital budgeting technique that is both theoretically correct and sensitive to the special financing needs of the small business. This technique involves evaluating cash flows and determining if they are sufficient to meet the loan payment schedule. A sufficient amount of cash flow must remain after debt obligations are met to compensate the equity investment. Net operating cash flows are discounted at the cost of equity while the tax shield from interest and depreciation is discounted at the cost of debt

A Proposed Capital Budgeting Technique For Liquidity Constrained Small Businesses

Although the ad vantages of capital budgeting models using discounted cash flaws are well known, small businesses continue to rely on non-discounted techniques in making capital budgeting decisions. This paper analyzes the financial environment in which small businesses operate that makes traditional capital budgeting models inappropriate. A capital budgeting technique is developed that is sensitive to the needs of small businesses and also meets the three-fold criteria for capital budgeting methods.