Comparative Effectiveness Review Within the U.K.'s National Institute for Health and Clinical Excellence

Examines lessons from the National Institute for Health and Clinical Excellence's use of comparative effectiveness reviews and decision-making process on evidence-based standards, uptake of medical innovations, and investment for maximum health benefit

Paying for "End-of-Life" Drugs in Australia, Germany, and the United Kingdom: Balancing Policy, Pragmatism, and Societal Values

Analyzes British, Australian, and German health systems' policies on covering expensive end-of-life drugs while maintaining equity and efficiency, such as requiring evidence of comparative clinical and cost-effectiveness. Outlines challenges for the U.S

The International Right to Health: What Does It Mean in Legal Practice and How Can It Affect Priority Setting for Universal Health Coverage?

The international right to health is enshrined in national and international law. In a growing number of cases, individuals denied access to high-cost medicines and technologies under universal coverage systems have turned to the courts to challenge the denial of access as against their right to health. In some instances, patients seek access to medicines, services, or technologies that they would have access to under universal coverage if not for government, health system, or service delivery shortfalls. In others, patients seek access to medicines, services, or technologies that have not been included or that have been explicitly denied for coverage due to prioritization. In the former, judicialization of the right to health is critical to ensure patients access to the technologies or services to which they are entitled. In the latter, courts may grant patients access to medicines not covered as a result of explicit priority setting to allocate finite resources. By doing so, courts may give priority to those with the means and incentive to turn to the courts, at the expense of the maximization of equity- and population-based health. Evidence- based, informed decision-making processes could ensure that the most clinically and cost-effective products aligning with social value judgments are prioritized. Governments should be equipped to engage in and defend rational priority setting as a means to promote fair allocation of resources to maximize population health. Rational priority setting is an evidence-based form of explicit priority setting, where the priority setting process is deliberate and transparent, the decision makers are specified, relevant stakeholders are involved, and the best available evidence about clinical and cost-effectiveness and social values is considered. The most rational priority setting processes will also account for the benefit to patients, the cost, the ethicality and the fairness. The priority setting process and institutions involved should then be held accountable through an appeals process, allowing independent review by health systems, health care, and other relevant experts, and an opportunity for judicial review. While the implementation of a three-step (1) rational priority setting, (2) appeals, and (3) judicial review process will differ depending on a country’s resource constraints, political systems, and social values, the authors argue that the three stages together will promote the greatest accountability and fairness. As a result, the courts could place greater reliance on the government’s coverage choices, and the population’s health could be most equitably distributed

Coverage with evidence development: applications and issues

Copyright © Cambridge University Press, 2010OBJECTIVES: The aim of this study was to describe the current issues surrounding Coverage with Evidence Development (CED). CED is characterized by restricted coverage for a new technology in parallel with targeted research when the stated goal of the research or data collection is to provide definitive evidence for the clinical or cost-effectiveness impact of the new technology. METHODS: Presented here is information summarized and interpreted from presentations and discussions at the 2008 Health Technology Assessment International (HTAi) meeting and additional information from the medical literature. This study describes the differences between CED and other conditional coverage agreements, provides a brief history of CED, describes real-world examples of CED, describes the areas of consensus between the stakeholders, discusses the areas for future negotiation between stakeholders, and proposes criteria to assist stakeholders in determining when CED could be appropriate. RESULTS: Payers could interpret the evidence obtained from a CED program either positively or negatively, and a range of possible changes to the reimbursement status of the new technology may result. Striking an appropriate balance between the demands for prompt access to new technology and acknowledging that some degree of uncertainty will always exist is a critical challenge to the uptake of this innovative form of conditional coverage. CONCLUSIONS: When used selectively for innovative procedures, pharmaceuticals, or devices in the appropriate disease areas, CED may provide patients access to promising medicines or technologies while data to minimize uncertainty are collected.The development of the manuscript was funded by Medicines Australi

How should global fund use value-for-money information to sustain its investments in graduating countries?

It has been debated whether the Global Fund (GF), which is supporting the implementation of programs on the prevention and control of HIV/AIDS, tuberculosis (TB) and malaria, should consider the value-for-money (VFM) for programs/interventions that they are supporting. In this paper, we critically analyze the uses of economic information for GF programs, not only to ensure accountability to their donors but also to support country governments in continuing investment in cost-effective interventions initiated by the GF despite the discontinuation of financial support after graduation. We demonstrate that VFM is not a static property of interventions and may depend on program start-up cost, economies of scales, the improvement of effectiveness and efficiency of providers once the program develops, and acceptance and adherence of the target population. Interventions that are cost-ineffective in the beginning may become cost-effective in later stages. We consider recent GF commitments towards value for money and recommend that the GF supports interventions with proven cost-effectiveness from program initiation as well as interventions that may be cost-effective afterwards. Thus, the GF and country governments should establish mechanisms to monitor cost-effectiveness of interventions invested over time

Capacity for health economics research and practice in Jordan, Lebanon, the occupied Palestinian territories and Turkey: needs assessment and options for development

Background: Capacity for health economics analysis and research is indispensable for evidence-informed allocations of scarce health resources, however little is known about the experience and capacity strengthening preferences of academics and practitioners in the Eastern Mediterranean region. This study aimed to assess the needs for strengthening health economics capacity in Jordan, Lebanon, the occupied Palestinian territories and Turkey as part of the Research for Health in Conflict in Middle East and North Africa (R4HC-MENA) project. Methods: Bibliometric analysis of health economics outputs combined with an online survey of academic researchers and non-academic practitioners. The bibliometric analysis was based on a literature search conducted across seven databases. Included records were original studies and reviews with an explicit economic outcome related to health, disease or disability; had at least one author in Jordan, Lebanon, Palestine or Turkey; and were published between January 2014 and December 2018. Two types of analyses were conducted using VOSviewer software: keyword co-occurrence; and co-publication networks across countries and organizations. The online survey asked academic researchers, analysts and decision-makers – identified through the bibliometric analysis and regional professional networks – about previous exposure to and preference for capacity development in health economics. Results: Of 15,185 records returned by the literature search, 566 were included in the bibliometric analysis. Organizations in Turkey contributed more than 80% of records and had the broadest and most diverse network of collaborators, nationally and internationally. Only 1% (n=7) studies were collaborations between researchers in two or more different jurisdictions. Cost analysis, cost-effectiveness analysis and health system economics were the main health economics topics across the included studies. Economic evaluation, measuring the economic burden of disease and health equity were reported by survey respondents (n=80) as the most important areas to develop in. Short courses, learn-by-doing and mentoring from an experienced professional were, in aggregate, the most preferred capacity development modalities. Conclusions: Existing pockets of health economic expertise in the region can constitute the base of future capacity development efforts. Building confidence toward applying specific methods and trust toward stimulating cross-jurisdiction collaborations appear essential components for sustainably developing health economics capacity

We need a NICE for global development spending

With aid budgets shrinking in richer countries and more money for healthcare becoming available from domestic sources in poorer ones, the rhetoric of value for money or improved efficiency of aid spending is increasing. Taking healthcare as one example, we discuss the need for and potential benefits of (and obstacles to) the establishment of a national institute for aid effectiveness. In the case of the UK, such an institute would help improve development spending decisions made by DFID, the country's aid agency, as well as by the various multilaterals, such as the Global Fund, through which British aid monies is channelled. It could and should also help countries becoming increasingly independent from aid build their own capacity to make sure their own resources go further in terms of health outcomes and more equitable distribution. Such an undertaking will not be easy given deep suspicion amongst development experts towards economists and arguments for improving efficiency. We argue that it is exactly because needs matter that those who make spending decisions must consider the needs not being met when a priority requires that finite resources are diverted elsewhere. These chosen unmet needs are the true costs; they are lost health. They must be considered, and should be minimised and must therefore be measured. Such exposition of the trade-offs of competing investment options can help inform an array of old and newer development tools, from strategic purchasing and pricing negotiations for healthcare products to performance based contracts and innovative financing tools for programmatic interventions

Management of a Solitary Bone Metastasis to the Tibia from Colorectal Cancer

The onset of osseous metastases during the course of colorectal cancer is not common. When they appear they are usually combined with visceral metastases to the liver, lungs and brain. In our report we refer to the case of a 78-year-old patient who presented a solitary bone metastasis from rectal carcinoma in the middle of his right tibia. A year before he had been operated for a Dukes stage B1 adenocarcinoma of the rectum. The rest of the check was negative for other metastases. He received external radiotherapy and capecitabine with bisphosphonates as palliative treatment. 19 months after the original diagnosis of bone metastasis the patient has stable disease

The international right to health: what does it mean in legal practice and how can it affect priority setting for universal health coverage?

The international right to health is enshrined in national and international law. In a growing number of cases, individuals denied access to high-cost medicines and technologies under universal coverage systems have turned to the courts to challenge the denial of access as against their right to health. In some instances, patients seek access to medicines, services, or technologies that they would have access to under universal coverage if not for government, health system, or service delivery shortfalls. In others, patients seek access to medicines, services, or technologies that have not been included or that have been explicitly denied for coverage due to prioritization. In the former, judicialization of the right to health is critical to ensure patients access to the technologies or services to which they are entitled. In the latter, courts may grant patients access to medicines not covered as a result of explicit priority setting to allocate finite resources. By doing so, courts may give priority to those with the means and incentive to turn to the courts, at the expense of the maximization of equity- and population-based health. Evidence-based, informed decision-making processes could ensure that the most clinically and cost-effective products aligning with social value judgments are prioritized. Governments should be equipped to engage in and defend rational priority setting, and the priority setting process and institutions involved should be held accountable through an opportunity for appeal and judicial review. As a result, the courts could place greater reliance on the government's coverage choices, and the population's health could be most equitably distributed

Conflict Management Style Preferences and Personality Traits of Unit Leaders Within Recreation, Parks, and Leisure Studies

Investigation of conflict management style preferences and personality traits of unit leaders in baccalaureate programs within recreation, parks, and leisure studies curricula. Two hundred sixty unit leaders, which accounted for all the population of unit leaders, were sent the survey through SurveyMonkey. A demographics questionnaire, the Rahim Organizational Conflict Inventory II (ROCI-II) Form C and the NEO Five-Factor Inventory (NEO-FFI) Form S were used for the web-based survey to collect data. This design method integrated elements of Dillman's Total Design Method (TDM) and recent literature on Web-based survey techniques.School of Teaching and Curriculum Leadershi