Resource allocation and economic evaluation in Australia’s healthcare system
Abdolvahab Baghbanian A B C D , Ian Hughes B and Freidoon A. Khavarpour BA Health Promotion Research Centre, Faculty of Health, Zahedan University of Medical Sciences, Mashahir Square, Zahedan, 98169-13396, Iran.
B Faculty of Health Sciences, The University of Sydney, Cumberland Campus, PO Box 170, Lidcombe NSW 2141 Australia. Email: ian.hughes@sydney.edu.au; freidoon@tpgi.com.au
C Menzies Centre for Health Policy, Victor Coppleson Building (D02), The University of Sydney, NSW 2006, Australia.
D Corresponding author. Email: abag2253@uni.sydney.edu.au
Australian Health Review 35(3) 278-283 https://doi.org/10.1071/AH10890
Submitted: 21 February 2010 Accepted: 4 November 2010 Published: 25 August 2011
Abstract
Objective. To explore dimensions and varieties of economic evaluations that healthcare decision-makers do or do not use.
Design. Web-based survey.
Setting and participants. A purposive sample of Australian healthcare decision-makers was recruited by direct invitation through email. All were invited to complete an online questionnaire derived from the EUROMET 2004 survey.
Results. A total of 91 questionnaires were analysed. Almost all participants were involved in financial resource allocations. Most commonly, participants based their decisions on patient needs, effectiveness of interventions, cost of interventions or overall budgetary effect, and policy directives. Evidence from cost-effectiveness analysis was used by half of the participants. Timing, ethical issues and lack of knowledge about economic evaluation were the most significant barriers to the use of economic evaluations in resource allocation decisions. Most participants reported being moderately to very familiar with the cost-effectiveness analysis. There was a general impression that evidence from economic evaluations should play a larger role in the future.
Conclusions. Evidence from health economic evaluations may provide valuable information in some decisions; however, at present, it is not central to many decisions. The study suggests that, for economic evaluation to be helpful in real-life policy decisions, it has to be placed into context – a context which is complex, political and often resistant to voluntary change.
What is known about the topic? There are increasing calls for the use of evidence from formal economic evaluations to improve the quality of healthcare decision making; however, it is widely acknowledged that such evidence, as presently constituted, is underused in its influence on allocation decisions.
What does this paper add? This study highlights that resource allocation decisions cannot be purely based on the use of technical, economic data or systematic evidence-based reviews. In order to exploit the full potential value of economic evaluations, researchers need to make better sense of decision contexts at specific times and places.
What are the implications for practitioners? The study has the potential to expand researchers and policy-makers’ understanding of the limited use of economic evaluation in decision-making. It produces evidence that decision-making in Australia’s healthcare system is not or cannot be a fully rational bounded process. Economic evaluation is used in some contexts, where information is accurate, complete and available.
References
[1] Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy 2008; 86 129–41.| A systematic review of the use of economic evaluation in local decision-making.Crossref | GoogleScholarGoogle Scholar |
[2] Duthie T, Trueman P, Chancellor J, Diez L. Research into the use of health economics in decision-making in the United Kingdom – Phase II. Is health economics ‘for good or evil?’ Health Policy 1999; 46 143–57.
| Research into the use of health economics in decision-making in the United Kingdom – Phase II. Is health economics ‘for good or evil?’Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M3gt1emtA%3D%3D&md5=cb7fd4b513876f0049820952998b03bbCAS |
[3] Drummond MF, Brown R, Fendrick AM, Fullerton P, Neumann P, Taylor R, et al. Use of pharmacoeconomics information. Report of the ISPOR Task Force on use of pharmacoeconomic/health economic information in healthcare decision-making. Value Health 2003; 6 407–16.
| Use of pharmacoeconomics information. Report of the ISPOR Task Force on use of pharmacoeconomic/health economic information in healthcare decision-making.Crossref | GoogleScholarGoogle Scholar |
[4] Hoffmann C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do healthcare decision-makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value Health 2002; 5 71–8.
| Do healthcare decision-makers find economic evaluations useful? The findings of focus group research in UK health authorities.Crossref | GoogleScholarGoogle Scholar |
[5] Eberhardt S, Stoklossa C, Schulenburg J-MGVD, editors. EUROMET 2004: The influence of economic evaluation studies on healthcare decision-making: A European survey. Amsterdam: IOS Press; 2005.
[6] van Velden ME, Severens JL, Novak A. Economic evaluations of healthcare programmes and decision-making: the influence of economic evaluations on different healthcare decision-making levels. Pharmacoeconomics 2005; 23 1075–82.
| Economic evaluations of healthcare programmes and decision-making: the influence of economic evaluations on different healthcare decision-making levels.Crossref | GoogleScholarGoogle Scholar |
[7] Gallego G, van Gool K, Kelleher D. Resource allocation and health technology assessment in Australia: views from the local level. Int J Technol Assess Health Care 2009; 25 134–40.
| Resource allocation and health technology assessment in Australia: views from the local level.Crossref | GoogleScholarGoogle Scholar |
[8] Williams IP, Bryan S. Understanding the limited impact of economic evaluation in healthcare resource allocation: a conceptual framework. Health Policy 2007; 80 135–43.
| Understanding the limited impact of economic evaluation in healthcare resource allocation: a conceptual framework.Crossref | GoogleScholarGoogle Scholar |
[9] Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee. Version 4.3. Canberra: Pharmaceutical Benefits Advisory Committee; 2008. Available at http://www.health.gov.au/internet/main/publishing.nsf/content/AECB791C29482920CA25724400188EDB/$File/PBAC4.3.2.pdf [verified 6 July 2011].
[10] Mooney G, Russell E. Equity in healthcare: the need for a new economics paradigm? In: Scott A, Maynard A, Elliott R, editors. Advances in Health Economics. Chichester, UK: Wiley; 2003.
[11] Anis AH, Gagnon Y. Using economic evaluations to make formulary coverage decisions so much for guidelines. Pharmacoeconomics 2000; 18 55–62.
| Using economic evaluations to make formulary coverage decisions so much for guidelines.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2Fgs1ersg%3D%3D&md5=0fd15b3357d6fe6301d737c06e901b16CAS |
[12] National Institute for Clinical Excellence. Guide to the methods of technology appraisal. 2004. Available at http://www.nice.org.uk/niceMedia/pdf/TAP_Methods.pdf [verified 6 July 2011].
[13] Brazier J, Ratcliffe J, Salomon J, Tsuchiya A. Measuring and Valuing Health Benefits for Economic Evaluation. 1st edn. New York: Oxford University Press; 2007.
[14] Hill SR, Mitchell AS, Henry DA. Problems with the interpretation of pharmacoeconomic analyses: A review of submissions to the Australian Pharmaceutical Benefits Scheme. JAMA 2000; 283 2116–21.
| Problems with the interpretation of pharmacoeconomic analyses: A review of submissions to the Australian Pharmaceutical Benefits Scheme.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c3ltVWnsA%3D%3D&md5=f9b781e473cb26a6faca1357cb47c5d7CAS |
[15] Armstrong BK, Gillespie JA, Leeder SR, Rubin GL, Russell LM. Challenges in health and healthcare for Australia. Med J Aust 2007; 187 485–9.
[16] Hailey D. Australian economic evaluation and government decisions on pharmaceuticals, compared to assessment of other health technologies. Soc Sci Med 1997; 45 563–81.
| Australian economic evaluation and government decisions on pharmaceuticals, compared to assessment of other health technologies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szntVCgsQ%3D%3D&md5=36ee83aaba6e907e88b81ef531bc194dCAS |
[17] Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ 2008; 336 1281–3.
| Complex interventions or complex systems? Implications for health economic evaluation.Crossref | GoogleScholarGoogle Scholar |
[18] Byford S, Sefton T. Economic evaluation of complex health and social care interventions. Natl Inst Econ Rev 2003; 186 98–108.
[19] Ross J. The use of economic evaluation in healthcare: Australian decision-makers’ perceptions. Health Policy 1995; 31 103–10.
| The use of economic evaluation in healthcare: Australian decision-makers’ perceptions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M3ivFGnsA%3D%3D&md5=eaed3e2a0d0005c70306b481a2bbce3dCAS |
[20] Gillam S, Yates J, Badrinath P. Essential Public Health: Theory and Practice. Cambridge, UK: Cambridge University Press; 2007.
[21] Mannion R, Small N, Thompson C. Alternative futures for health economics: Implications for nursing management. J Nurs Manag 2005; 13 377–86.
| Alternative futures for health economics: Implications for nursing management.Crossref | GoogleScholarGoogle Scholar |
[22] Mannion R, Small N. Postmodern health economics. Health Care Anal 1999; 7 255–72.
| Postmodern health economics.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FgtFOgsg%3D%3D&md5=a26ebab9b6b50fccb4aae0ba1050d7a9CAS |
[23] Richardson J, McKie J. Empiricism, ethics and orthodox economic theory: What is the appropriate basis for decision-making in the health sector. Soc Sci Med 2005; 60 265–75.
| Empiricism, ethics and orthodox economic theory: What is the appropriate basis for decision-making in the health sector.Crossref | GoogleScholarGoogle Scholar |
[24] Lee RC, Donaldson C, Cook LS. The need for evolution in healthcare decision modeling. Med Care 2003; 41 1024–33.
| The need for evolution in healthcare decision modeling.Crossref | GoogleScholarGoogle Scholar |
[25] Byng R, Jones R. Mental health link: The development and formative evaluation of a complex intervention to improve shared care for patients with long-term mental illness. J Eval Clin Pract 2004; 10 27–36.
| Mental health link: The development and formative evaluation of a complex intervention to improve shared care for patients with long-term mental illness.Crossref | GoogleScholarGoogle Scholar |
[26] Buxton MJ, Drummond MF, Hout BAV, Prince RL, Sheldon TA, Szucs T, et al. Modelling in economic evaluation: An unavoidable fact of life. Health Econ 1997; 6 217–27.
| Modelling in economic evaluation: An unavoidable fact of life.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szmvFKqsg%3D%3D&md5=dd46e4d2f0fd2ed24f66b38e5062ed27CAS |
[27] Hollnagel E. Decisions about what and decisions about how. In: Cook M, Noyes J, Masakowski Y, editors. Decision-making in Complex Environment. Aldershot, UK: Ashgate Publishing Limited; 2007.
[28] Healy SA. Changing science and ensuring our future. Futures 1997; 29 505–17.
| Changing science and ensuring our future.Crossref | GoogleScholarGoogle Scholar |
[29] Benson H. Chaos and complexity: applications for healthcare quality and patient safety. J Healthc Qual 2005; 27 4–10.
| Chaos and complexity: applications for healthcare quality and patient safety.Crossref | GoogleScholarGoogle Scholar |
[30] Wilson T, Holt T, Greenhalgh T. Complexity science: complexity and clinical care. BMJ 2001; 323 685–8.
| Complexity science: complexity and clinical care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrhvFChtw%3D%3D&md5=ab25bb3ec15fb95324da961da398cfc2CAS |
[31] Hammer PJ. Institutional economics for health policy? Health Aff 2003; 22 277–8.
| Institutional economics for health policy?Crossref | GoogleScholarGoogle Scholar |
[32] Hodgson GM. An institutional and evolutionary perspective on health economics. Camb J Econ Sociol 2008; 32 235–56.
| An institutional and evolutionary perspective on health economics.Crossref | GoogleScholarGoogle Scholar |
[33] Kurtz CF, Snowden DJ. The new dynamics of strategy: sense-making in a complex and complicated world. IBM Syst J 2003; 42 462–83.
| The new dynamics of strategy: sense-making in a complex and complicated world.Crossref | GoogleScholarGoogle Scholar |
