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Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart
Nathalie Eckard1, Magnus Janzon2, Lars-Åke Levin1
1Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Insights
Cost-effectiveness data is crucial for prioritizing healthcare resources in Swedish national guidelines. This data helps decision-makers allocate resources efficiently, especially when clinical evidence is uncertain or new technologies are introduced.
Area of Science:
- Health Economics
- Health Policy Research
- Decision Science
Background:
- Swedish national guidelines integrate cost-effectiveness data for healthcare priority setting.
- Guidelines aim to influence health policy and optimize scarce resource allocation.
- Medical conditions are prioritized based on severity, impacting resource distribution.
Purpose of the Study:
- To investigate how the Priority Setting Group (PSG) utilized cost-effectiveness data for ranking decisions in heart disease national guidelines.
- To explore the role of economic arguments in healthcare priority setting.
- To understand the practical application of health economics in guideline development.
Main Methods:
- Qualitative case study methodology.
- Exploration of cost-effectiveness data availability, understanding, and interpretation.
- Analysis of reliance on evidence and explicit use of economic arguments in decision-making.
Main Results:
- Cost-effectiveness data is integral to the decision-making process.
- Involvement of health economists and data reliance enhance its use.
- Economic arguments serve as a fine-tuning instrument and counterweight.
- Data is vital during clinical evidence uncertainty and for new technology adoption.
Conclusions:
- Cost-effectiveness data significantly influences healthcare decision-making.
- Findings are applicable to other jurisdictions implementing health economics.
- This study enhances understanding of data use for equitable and needs-based patient care.
Background:
The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases.
Methods:
A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions.
Results:
This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies.
Conclusion:
Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit.
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