Why do health economists promote technology adoption rather than the search for efficiency? A proposal for a change in our approach to economic evaluation in health care

Graham Scotland (Corresponding Author), Bryan Stirling

Research output: Contribution to journalArticle

9 Citations (Scopus)
8 Downloads (Pure)

Abstract

At a time of intense pressure on health care budgets, the technology management challenge is for disinvestment in low-value technologies and re-investment in higher value alternatives. The aim of this paper is to explore ways in which health economists might begin to redress the observed imbalance between the evaluation of new and existing in-use technologies. The argument is not against evaluating new technologies but in favour of the ‘search for efficiency’, where the ultimate objective is to identify reallocations that improve population health in the face of resource scarcity. We explore why in-use technologies may be of low value and consider how economic evaluation analysts might embrace a broader efficiency lens; first through ‘technology management’ (a process of analysis and evidence-informed decision making throughout a technology’s life-cycle) and progressing through ‘pathway management’ (the search for efficiency gains across entire clinical care pathways). A number of model-based examples are used to illustrate the approaches.
Original languageEnglish
Pages (from-to)139-147
Number of pages9
JournalMedical Decision Making
Volume37
Issue number2
Early online date17 Jun 2016
DOIs
Publication statusPublished - 1 Feb 2017

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Cost-Benefit Analysis
Technology
Delivery of Health Care
Health
Biomedical Technology
Critical Pathways
Budgets
Life Cycle Stages
Lenses
Decision Making
Pressure
Population

Keywords

  • health economics methods
  • decision analysis
  • economic evaluation
  • cost-effectiveness analysis

Cite this

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abstract = "At a time of intense pressure on health care budgets, the technology management challenge is for disinvestment in low-value technologies and re-investment in higher value alternatives. The aim of this paper is to explore ways in which health economists might begin to redress the observed imbalance between the evaluation of new and existing in-use technologies. The argument is not against evaluating new technologies but in favour of the ‘search for efficiency’, where the ultimate objective is to identify reallocations that improve population health in the face of resource scarcity. We explore why in-use technologies may be of low value and consider how economic evaluation analysts might embrace a broader efficiency lens; first through ‘technology management’ (a process of analysis and evidence-informed decision making throughout a technology’s life-cycle) and progressing through ‘pathway management’ (the search for efficiency gains across entire clinical care pathways). A number of model-based examples are used to illustrate the approaches.",
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note = "Acknowledgments Financial Support: HERU and HSRU receive a core grant from the Chief Scientist’s Office of the Scottish Government Health and Social Care Directorates, and the Centre for Clinical epidemiology & Evaluation is funded by Vancouver Coastal Health Authority. The model used for the illustrative case study in this paper was developed as part of a NHS Technology Assessment Review, funded by the National Institute for Health Research (NIHR) Health Technology Assessment Program (project number 09/146/01). The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the Scottish Government, NHS, Vancouver Coastal Health, NIHR HTA Program or the Department of Health. The authors wish to thank Kathleen Boyd and members of the audience at the UK Health Economists Study Group, for comments received on an earlier version of this paper. We also wish to thank Cynthia Fraser (University of Aberdeen) for literature searches undertaken to inform the manuscript, and Mohsen Sadatsafavi (University of British Columbia) for comments on an earlier draft.",
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