Publications
181 results found
Emerson J, Panzer A, Cohen JT, et al., 2019, Adherence to the iDSI reference case among published cost-per-DALY averted studies, PLOS ONE, Vol: 14, ISSN: 1932-6203
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- Citations: 22
Steuten L, Garau M, Gomez G, et al., 2019, HEALTH-ECONOMIC MODELLING TO INFORM PRIVATE SECTOR INVESTMENT IN INFECTIOUS DISEASE TREATMENTS IN MIDDLE-INCOME COUNTRIES: THE CASE OF TUBERCULOSIS, Publisher: ELSEVIER SCIENCE INC, Pages: S209-S209, ISSN: 1098-3015
Wu Y, Li S, Patel A, et al., 2019, Effect of a Quality of Care Improvement Initiative in Patients With Acute Coronary Syndrome in Resource-Constrained Hospitals in China: A Randomized Clinical Trial., JAMA Cardiol
Importance: Prior observational studies suggest that quality of care improvement (QCI) initiatives can improve the clinical outcomes of acute coronary syndrome (ACS). To our knowledge, this has never been demonstrated in a well-powered randomized clinical trial. Objective: To determine whether a clinical pathway-based, multifaceted QCI intervention could improve clinical outcomes among patients with ACS in resource-constrained hospitals in China. Design, Setting, Participants: This large, stepped-wedge cluster randomized clinical trial was conducted in nonpercutaneous coronary intervention hospitals across China and included all patients older than 18 years and with a final diagnosis of ACS who were recruited consecutively between October 2011 and December 2014. We excluded patients who died before or within 10 minutes of hospital arrival. We recruited 5768 and 0 eligible patients for the control and intervention groups, respectively, in step 1, 4326 and 1365 in step 2, 3278 and 3059 in step 3, 1419 and 4468 in step 4, and 0 and 5645 in step 5. Interventions: The intervention included establishing a QCI team, training clinical staff, implementing ACS clinical pathways, sequential site performance assessment and feedback, online technical support, and patient education. The usual care was the control that was compared. Main Outcomes and Measures: The primary outcome was the incidence of in-hospital major adverse cardiovascular events (MACE), comprising all-cause mortality, reinfarction/myocardial infarction, and nonfatal stroke. Secondary outcomes included 16 key performance indicators (KPIs) and the composite score developed from these KPIs. Results: Of 29 346 patients (17 639 men [61%]; mean [SD] age for control, 64.1 [11.6] years; mean [SD] age for intervention, 63.9 [11.7] years) who were recruited from 101 hospitals, 14 809 (50.5%) were in the control period and 14 537 (49.5%) were in the intervention period. There was no significant difference in the incidence
Littlejohns P, Chalkidou K, Culyer AJ, et al., 2019, National Institute for Health and Care Excellence, social values and healthcare priority setting., J R Soc Med, Pages: 141076819842846-141076819842846
Skinner J, Chalkidou K, Jamison DT, 2019, Valuing protection against health-related financial risks, Journal of Benefit-Cost Analysis, Vol: 10, Pages: 106-131, ISSN: 2194-5888
There is strong interest in both developing and developed countries toward expanding health insurance coverage. How should the benefits, and costs, of expanded coverage be measured? While the value of reducing the financial risks that result from insurance coverage have long been recognized, there has been less attention in how best to measure such benefits. In this paper, we first provide a framework for assessing the financial value from health insurance. We focus on three distinct potential benefits: Pooling the risk of unexpected medical expenditures between healthy and sick households, redistributing resources from high- to low-income recipients and smoothing consumption over time. We then use this theoretical framework and an illustrative example to provide practical guidelines for benefit-cost analysis in capturing the full benefits (and costs) of expanding health insurance coverage. We conclude by considering other potential financial effects of broad insurance coverage, such as the ability to consolidate purchases and thus lower input prices.
Isaranuwatchai W, Li R, Glassman A, et al., 2019, Disease Control Priorities Third Edition: Time to put a theory of change into practice; Comment on "Disease Control Priorities Third Edition is published: A theory of change is needed for translating evidence to health policy", International Journal of Health Policy and Management, Vol: 8, Pages: 132-135, ISSN: 2322-5939
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
Hauck K, Morton A, Chalkidou K, et al., 2019, How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations, Social Science and Medicine, Vol: 220, Pages: 141-149, ISSN: 0277-9536
Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.
Culyer AJ, Chalkidou K, 2019, Economic Evaluation for Health Investments En Route to Universal Health Coverage: Cost-Benefit Analysis or Cost-Effectiveness Analysis?, VALUE IN HEALTH, Vol: 22, Pages: 99-103, ISSN: 1098-3015
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- Citations: 19
Dabak SV, Pilasant S, Mehndiratta A, et al., 2018, Budgeting for a billion: applying health technology assessment (HTA) for universal health coverage in India., Health Research Policy and Systems, Vol: 16, Pages: 115-115
BACKGROUND: India recently launched the largest universal health coverage scheme in the world to address the gaps in providing healthcare to its population. Health technology assessment (HTA) has been recognised as a tool for setting priorities as the government seeks to increase public health expenditure. This study aims to understand the current situation for healthcare decision-making in India and deliberate on the opportunities for introducing HTA in the country. METHODS: A paper-based questionnaire, adapted from a survey developed by the International Decision Support Initiative (iDSI), was administered on the second day of the Topic Selection Workshop that was conducted as part of the HTA Awareness Raising Workshop held in New Delhi on 25-27 July, 2016. Participants were invited to respond to questions covering the need, demand and supply for HTA in their context as well as the role of their organisation vis-à-vis HTA. The response rate for the survey was about 68% with 41 participants having completed the survey. RESULTS: Three quarters of the respondents (71%) stated that the government allocated healthcare resources on the basis of expert opinion. Most respondents indicated reimbursement of individual health technologies and designing a basic health benefit package (93% each) were important health policy areas while medical devices and screening programmes were cited as important technologies (98% and 92%, respectively). More than half of the respondents noted that relevant local data was either not available or was limited. Finally, technical capacity was seen as a strength and a constraint facing organisations. CONCLUSION: The findings from this study shed light on the current situation, the opportunities, including potential topics, and challenges in conducting HTA in India. There are limitations to the study and further studies may need to be conducted to inform the role that HTA will play in the design or implementation of universal health cover
Marsh K, Thokala P, Youngkong S, et al., 2018, Incorporating MCDA into HTA: challenges and potential solutions, with a focus on lower income settings, COST EFFECTIVENESS AND RESOURCE ALLOCATION, Vol: 16, ISSN: 1478-7547
Friebel R, Molloy A, Leatherman S, et al., 2018, Achieving high-quality universal health coverage: a perspective from the National Health Service in England, BMJ GLOBAL HEALTH, Vol: 3, ISSN: 2059-7908
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- Citations: 11
Reddy P, Desai R, Sifunda S, et al., 2018, "You Travel Faster Alone, but Further Together": Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant, INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, Vol: 7, Pages: 977-981, ISSN: 2322-5939
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- Citations: 6
Chi Y-L, Gad M, Bauhoff S, et al., 2018, Mind the costs, too: towards better cost-effectiveness analyses of PBF programmes, BMJ Global Health, Vol: 3, Pages: e000994-e000994, ISSN: 2059-7908
Koffijberg H, Rothery C, Chalkidou K, et al., 2018, Value of Information Choices that Influence Estimates: A Systematic Review of Prevailing Considerations, MEDICAL DECISION MAKING, Vol: 38, Pages: 888-900, ISSN: 0272-989X
Bennett JE, Stevens GA, Mathers CD, et al., 2018, NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4, Lancet, Vol: 392, Pages: 1072-1088, ISSN: 0140-6736
The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4—a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030—will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010–2016 rate of decline in NCD mortality. Most of these are high-income c
Alshreef A, Macquilkan K, Dawkins B, et al., 2018, ASSESSING THE APPROPRIATENESS OF EXISTING MODEL ADAPTATION METHODS FOR LOW AND MIDDLE-INCOME COUNTRIES, Publisher: ELSEVIER SCIENCE INC, Pages: S8-S8, ISSN: 1098-3015
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- Citations: 2
Webber L, Chalkidou K, Morrow S, et al., 2018, What are the best societal investments for improving people's health?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 362, ISSN: 1756-1833
Sirohi B, Chalkidou K, Pramesh CS, et al., 2018, Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres, LANCET ONCOLOGY, Vol: 19, Pages: E395-E406, ISSN: 1470-2045
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- Citations: 25
Teerawattananon Y, Luz K, Yothasmutra C, et al., 2018, HISTORICAL DEVELOPMENT OF THE HTAsiaLINK NETWORK AND ITS KEY DETERMINANTS OF SUCCESS, INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, Vol: 34, Pages: 260-266, ISSN: 0266-4623
Scuffham PA, Krinks R, Chalkidou K, et al., 2018, Recommendations from Two Citizens' Juries on the Surgical Management of Obesity (vol 28, pg 1745, 2018), OBESITY SURGERY, Vol: 28, Pages: 1753-1753, ISSN: 0960-8923
Scuffham PA, Krinks R, Chaulkidou K, et al., 2018, Recommendations from Two Citizens' Juries on the Surgical Management of Obesity, OBESITY SURGERY, Vol: 28, Pages: 1745-1752, ISSN: 0960-8923
Downey L, Rao N, Guinness L, et al., 2018, Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India [version 2; peer-reviewed: 3approved], F1000Research, Vol: 7, ISSN: 2046-1402
Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for e
Norman R, Chalkidou K, Culyer AJ, 2018, A Health Economics Approach to US Value Frameworks: Serving the Needs of Decision Making, VALUE IN HEALTH, Vol: 21, Pages: 117-118, ISSN: 1098-3015
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- Citations: 7
MacQuilkan K, Baker P, Downey L, et al., 2018, Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa., Global health action, Vol: 11, Pages: 1527556-1527556, ISSN: 1654-9716
BACKGROUND: Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. OBJECTIVES: This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. METHODS: A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. RESULTS: Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. CONCLUSION: China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among cou
Culyer A, Chalkidou K, Teerawattananon Y, et al., 2018, Rival perspectives in health technology assessment and other economic evaluations for investing in global and national health. Who decides? Who pays?, F1000Res, Vol: 7, ISSN: 2046-1402
There seems to be a general agreement amongst practitioners of economic evaluations, including Health Technology Assessment, that the explicit statement of a perspective is a necessary element in designing and reporting research. Moreover, there seems also to be a general presumption that the ideal perspective is "societal". In this paper we endorse the first principle but dissent from the second. A review of recommended perspectives is presented. The societal perspective is frequently not the one recommended. The societal perspective is shown to be less comprehensive than is commonly supposed, is inappropriate in many contexts and, in any case, is in general not a perspective to be determined independently of the context of a decision problem. Moreover, the selection of a perspective, societal or otherwise, is not the prerogative of analysts.
Chalkidou K, 2017, Is competition bad for our health(care)? We simply don't know, LANCET ONCOLOGY, Vol: 18, Pages: 1424-+, ISSN: 1470-2045
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- Citations: 1
Chalkidou K, Culyer AJ, Glassman A, et al., 2017, We need a NICE for global development spending., F1000Research, Vol: 6, Pages: 1223-1223, ISSN: 2046-1402
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.
Brownlee S, Chalkidou K, Doust J, et al., 2017, Evidence for overuse of medical services around the world, LANCET, Vol: 390, Pages: 156-168, ISSN: 0140-6736
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- Citations: 497
Li R, Ruiz F, Culyer AJ, et al., 2017, Evidence-informed capacity building for setting health priorities in low- and middle-income countries: A framework and recommendations for further research., F1000Research, Vol: 6, Pages: 231-231, ISSN: 2046-1402
Priority-setting in health is risky and challenging, particularly in resource-constrained settings. It is not simply a narrow technical exercise, and involves the mobilisation of a wide range of capacities among stakeholders - not only the technical capacity to "do" research in economic evaluations. Using the Individuals, Nodes, Networks and Environment (INNE) framework, we identify those stakeholders, whose capacity needs will vary along the evidence-to-policy continuum. Policymakers and healthcare managers require the capacity to commission and use relevant evidence (including evidence of clinical and cost-effectiveness, and of social values); academics need to understand and respond to decision-makers' needs to produce relevant research. The health system at all levels will need institutional capacity building to incentivise routine generation and use of evidence. Knowledge brokers, including priority-setting agencies (such as England's National Institute for Health and Care Excellence, and Health Interventions and Technology Assessment Program, Thailand) and the media can play an important role in facilitating engagement and knowledge transfer between the various actors. Especially at the outset but at every step, it is critical that patients and the public understand that trade-offs are inherent in priority-setting, and careful efforts should be made to engage them, and to hear their views throughout the process. There is thus no single approach to capacity building; rather a spectrum of activities that recognises the roles and skills of all stakeholders. A range of methods, including formal and informal training, networking and engagement, and support through collaboration on projects, should be flexibly employed (and tailored to specific needs of each country) to support institutionalisation of evidence-informed priority-setting. Finally, capacity building should be a two-way process; those who build capacity should also attend to their own capacity
Chalkidou K, 2017, Comparative effectiveness research around the globe: a valuable tool for achieving and sustaining universal healthcare, JOURNAL OF COMPARATIVE EFFECTIVENESS RESEARCH, Vol: 6, Pages: 89-93, ISSN: 2042-6305
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