Decision Makers’ Attitudes to Cost Effectiveness Analysis Shoshanna Sofaer, Dr.P.H. School of Public Affairs Baruch College.

Slides:



Advertisements
Similar presentations
MIXED METHODS IN HEALTH SERVICES & POLICY RESEARCH Shoshanna Sofaer, Dr.P.H. School of Public Affairs Baruch College.
Advertisements

Post Research Benefits Mandika Wijeyaratne MS, MD, FRCS Dept. of Surgery, Colombo.
Language Attributes and Older Adults: Implications for Medicare Policy Ninez Ponce, PhD,MPP 1,2 ; Leighton Ku, PhD 4 ; William.
Labor’s Fight to Get Medicare for All Reg Clark & Matthew Kogan Labor United for Universal Health Care Healthy California Campaign 3 rd Annual Summer Conference.
Laura L. McDermott, PhD, FNP, RN Gale A. Spencer, PhD, RN Binghamton University Decker School of Nursing THE RELATIONSHIP AMONG BARRIERS AND FACILITATORS.
Capacities, Challenges, and Opportunities. Introduction Challenges to reducing health disparities in the United States Poor diffusion of knowledge on.
Quality improvement for asthma care: The asthma care return-on-investment calculator Ginger Smith Carls, M.A., Thomson Healthcare (Medstat) State Healthcare.
Cancer Disparities Research Partnership Program Process & Outcome Evaluation Amanda Greene, PhD, MPH, RN Paul Young, MBA, MPH Natalie Stultz, MS NOVA Research.
Our Group Plan for a Mixed Methods Study by John W. Creswell, Ph.D. and Vicki L. Plano Clark, M.S. University of Nebraska-Lincoln
Decision Analysis as a Basis for Estimating Cost- Effectiveness: The Experience of the National Institute for Health and Clinical Excellence in the UK.
Research Design Mixed Methods
Metropolitan Life Insurance Company 200 Park Avenue, New York, NY L (exp0711)MLIC-LD Overview Mexico India Australia U.K. Study Methodology.
Dobson DaVanzo & Associates, LLC Vienna, VA Prostate Cancer Patients Report on Benefits of Proton Therapy: Follow- on.
The Role of Consumer Knowledge on the Demand for Preventive Health Care Among the Elderly Stephen T. Parente, Ph.D., Project HOPE Center for Health Affairs.
1 Consumer Knowledge of Health Insurance Plans and Affordability of Care: An Emergency Department Survey in Three Diverse Communities Massachusetts Center.
Is this Research? Exempt? Expedited?
Knowledge and Practice of Blood Transfusion: A Survey of Nurses in Abu Dhabi, United Arab Emirates. Belal M. Hijji 1, Kader Parahoo 1, Mohammad M. Hossain.
3rd Baltic Conference on Medicines Economic Evaluation, Reimbursement and Rational Use of Pharmaceuticals Pricing and Reimbursement of Pharmaceuticals.
COMPARATIVE EFFECTIVENESS RESEARCH Public Policy Interest and Issues Jeanne Lambrew, PhD Associate Professor LBJ School of Public Affairs National Health.
CHCWG DRAFT March 2, 2006 Hearing from the American People: Preliminary Overview of Sources and Reports March 2006 Caution: Preliminary Data Do not cite.
Stretching Scarce Resources: State Strategies to Design Effective, Affordable Benefit Packages Anne Markus, J.D., Ph.D. Senior Research Scientist The George.
Politics, Values and Interests: the Debate over Supplemental Insurance in Israel Prof. Revital Gross The Smokler Center for Health Policy Research, Myers-JDC-Brookdale.
State Health Access Reform Evaluation Lynn A. Blewett, Ph.D. State Health Access Data Assistance Center State Coverage Initiatives (SCI) National Meeting.
TEMPLATE DESIGN © Dev Kumari Shrestha Rai Maternal Health Nursing Department College of Nursing,BPKIHS,Nepal
Lynn Douglas Mouden, DDS, MPH Chief Dental Officer Centers for Medicare & Medicaid Services Oral Health: Putting a Smile in Public Housing.
1 CENTER for the ADVANCEMENT of ENGINEERING EDUCATION Lorraine N. Fleming, Ph.D. Co- Principal Investigator Howard University Kimarie Engerman, Ph.D. Senior.
Evaluating A Patient-Centered Medical Home from the Patient’s Perspective Betty M. Kennedy, PhD Community Outreach Specialist Community Outreach Specialist.
Needs Assessment: Young People’s Drug and Alcohol Services in Edinburgh City EADP Children, Young People and Families Network Event 7 th March 2012 Joanne.
Muskie School of Public Service Institute for Health Policy Evaluating the Impact of Part D on Beneficiaries: Early Lessons Susan Payne Institute for Health.
The Impact of Health Expenses on Older Women ’ s Financial Security Juliette Cubanski, Ph.D. The Henry J. Kaiser Family Foundation AcademyHealth 2007 Annual.
Evidence and Organizational Decision Making: Never the Twain Shall Meet? Thomas Rundall, PhD Academy Health, Annual Research Meeting June 27, 2006.
Shifting resources: disinvestment and re-investment Craig Mitton, PhD Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research.
Interdisciplinary Nursing Quality Research Initiative (INQRI): Developing And Testing Nursing Quality Measures with Consumers And Patients Christine Pintz.
Considerations in Public Reporting of the AHRQ QIs Shoshanna Sofaer, Dr.P.H. School of Public Affairs Baruch College.
1 Variation in Medicare Part D Prescription Drug Plan Benefits, 2006 Leslie M. Greenwald, Ph.D. Principal Scientist RTI, International.
FOCUS GROUP OR INTERVENTION? PUBLIC RESPONSES TO COST EFFECTIVENESS INFORMATION Shoshanna Sofaer, Dr.P.H. School of Public Affairs Baruch College.
MODEL FOR SURVEYING PARENTS AND YOUTH ABOUT OST Presented by Dr. Julie Pokela Market Street Research
Health care utilization behaviors of school-based health center users and non-users Gorette Amaral, MHS; Sara P. Geierstanger, MPH; Samira Soleimanpour,
Opportunities for Reform: The Long- Term Care Industry Perspective James E. Introne President and CEO Catholic Health Care System New York, NY.
1 Comparative Effectiveness Research: Key Issues and Controversies Consumer-Purchaser Disclosure Project Discussion Forum May 5, 2009 Steven D. Pearson,
Public Reporting: Bring Your Lunch and Make Connections Introduction to the AHRQ QI Learning Institute AHRQ Annual Meeting September 9, 2008.
Healthcare What are the issues?. Some interesting statistics- Uninsured by income level Some interesting statistics- Uninsured by income level (WA state.
Evidence, HTA and Comparative Effectiveness in the U.S. Presentation at AMCP March 28, 2007 Peter J. Neumann Tufts-New England Medical Center.
How Can Cost Effectiveness Analysis Be Made More Relevant to U.S. Health Care? Paul G. Barnett, PhD February 29, 2012.
Factors impacting implementation of a community coalition-driven evidence- based intervention: results from a cluster randomized controlled trial Methods.
Roundtable Discussion: Findings from the Florida Health Insurance Study, Phase II, Strategic Plan Discussion Agency for Health Care Administration University.
LOGO Mamdouh Abdel Aziz Refaiy Dr. Associate Professor, Business Administration Department, Faculty of Commerce, Ain Shams University, Cairo, Egypt. Evaluating.
Research Design Week 6 Part February 2011 PPAL 6200.
Flagship Program on Health Sector Reform and Sustainable Financing.
Survey Of KOICA Training Programs Evaluation Dear Participants This questionnaire survey is designed to evaluate the KOICA training program you attended.
Translating Emerging Evidence: Lessons from the MATCH Study (Methods for Developing Actionable Evidence for Consumers of Health Services Research) AcademyHealth.
Veterinarians as Partners in Public Health Preparedness: Qualitative and Quantitative Needs Assessment Results Elizabeth Ablah, PhD, MPH University of.
Estimating Effects and Inferring Implications 2016 Academic Academy Sacramento, CA Terrence Willett Senior Consulting Researcher RP Group.
1 6 th National Children & Young People Survivorship Workshop A GP perspective Una Macleod Professor of Primary Care Medicine Primary care cancer lead,
Comparative Effectiveness Research (CER) and Patient- Centered Outcomes Research (PCOR) Presentation Developed for the Academy of Managed Care Pharmacy.
8 Nobermer, 2010 Sungsoo Chun, MPH, PhD, Easton Reid, PhD, Mi-Kyung Kim Korean Institute on Alcohol Problems School of Health and Welfare, Sahmyook University,
Approaches to Linking Process and Outcome Data in a Cross-Site Evaluation Laura Elwyn, Ph.D. Kristin Stainbrook, Ph.D. American Evaluation Association.
Listening to Our Learners: Designing a Residency Evidence- based Medicine Curriculum Using a Learner-Driven Method Drew Keister, MD 55 MDG Family Medicine.
Premiums in 2018: What to Expect
Presentation Developed for the Academy of Managed Care Pharmacy
Capital Project / Infrastructure Renewal – Making the Business Case
Evaluation Period: January 1, 2016 – December
APHA 135th Annual Meeting and Expo November 3-7, 2007 Washington, DC
INNOVATIVE, INTERPROFESSIONAL SIMULATION
March 2006 Caution: Preliminary Data Do not cite or distribute
§ EUROPEAN ASSOCIATION OF SENIOR HOSPITAL PHYSICIANS Brussels 2018.
For PUBLIC SECTOR HEALTHCARE ROUNDTABLE NOVEMBER 2, 2017
Access Gaps in Dental Procedure Coverage for Medicare Beneficiaries and Dental Coverage Perceptions in Philadelphia J. Zefran1; R. Diecidue, DMD, MD, MBA,
Unit 14 Emergency Planning IS 235
Presentation transcript:

Decision Makers’ Attitudes to Cost Effectiveness Analysis Shoshanna Sofaer, Dr.P.H. School of Public Affairs Baruch College

June 5, 2007 Academy Health Annual Research Meeting2 The Research Team  Marthe R. Gold, M.D., M.P.H., Principal Investigator, Sophie Davis Medical College, City College of New York  Stirling Bryan, Ph.D., University of Birmingham, UK  Shoshanna Sofaer, Dr.P.H., School of Public Affairs, Baruch College  Taryn Siegelberg, M.P.P., Sophie Davis Medical College, City College of New York

June 5, 2007 Academy Health Annual Research Meeting3 Overview  Study Background and Purpose  Methods  Findings Quantitative Quantitative Qualitative Qualitative  Implications

June 5, 2007 Academy Health Annual Research Meeting4 Background  Cost effectiveness analysis (CEA) is rarely used to make coverage decisions in the US, although it is increasingly used in other developed nations. Why?  This study explored the attitudes of decision makers in the public and private sectors, in California, to CEA, to identify both support for this approach and barriers to its use.

June 5, 2007 Academy Health Annual Research Meeting5 Background  Study funded by the California Health Care Foundation; additional support provided through The Commonwealth Fund through a Harkness Fellowship provided to Stirling Bryan, Ph.D., health economist and participant in the British National Institute for Clinical Excellence (NICE)

June 5, 2007 Academy Health Annual Research Meeting6 Methods  Mixed method study  Six half-day workshops with California decision makers, including Health plans/insurers Health plans/insurers Purchasers Purchasers State Medicaid State Medicaid State Health Plan Regulator State Health Plan Regulator Multi-stakeholder coalition Multi-stakeholder coalition

June 5, 2007 Academy Health Annual Research Meeting7 Methods  Workshop included: Primer on CEA Primer on CEA Discussion of cases that reveal ethical issues inherent in CEA Discussion of cases that reveal ethical issues inherent in CEA Presentation of information on the CE ratios of 14 condition-treatment pairs Presentation of information on the CE ratios of 14 condition-treatment pairs Request for participants to act as “social” decision makers vis a vis the Medicare program Request for participants to act as “social” decision makers vis a vis the Medicare program

June 5, 2007 Academy Health Annual Research Meeting8 Methods  Also, Discussion of the work of NICE Discussion of the work of NICE Discussion of benefits and barriers to CEA in participants’ own organizational context Discussion of benefits and barriers to CEA in participants’ own organizational context  Workshops Included a range of senior decision makers (clinical and non-clinical); average n = 10; total n = 58 Included a range of senior decision makers (clinical and non-clinical); average n = 10; total n = 58 Lasted about 2.5 hours Lasted about 2.5 hours Were moderated by Dr. Bryan and either Dr. Gold or Dr. Sofaer or both Were moderated by Dr. Bryan and either Dr. Gold or Dr. Sofaer or both

June 5, 2007 Academy Health Annual Research Meeting9 Methods  Prior to workshop, participants got descriptions of the 14 condition-treatment pairs with information about their effectivness vis a vis Medicare population  They rank-ordered the 14: 5 definitely cover; 5 probably cover; 4 definitely not cover  They were also surveyed vis a vis demographics, attitudes and knowledge of CEA

June 5, 2007 Academy Health Annual Research Meeting10 Methods  After the workshop Second survey, with some of the same questions plus additional questions about the workshop and about problems with CEA Second survey, with some of the same questions plus additional questions about the workshop and about problems with CEA  Workshop discussions transcribed; discussion of benefits and barriers coded using NVivo  Pre- and post-surveys analyzed descriptively and comparatively  Rankings analyzed in terms of the difference in CEA ratio between treatment that received high and low priority, before and after CEA ratios were available

June 5, 2007 Academy Health Annual Research Meeting11 Findings  While 57% said they understood CEA at least reasonably well before the workshop, 91% rated themselves at that level after the workshop  While 51% said they personally supported health care rationing before the workshop, 59% said they supported it afterwards  In post workshop survey: 72% said CEA should be used in all coverage decisions, not just new treatments 72% said CEA should be used in all coverage decisions, not just new treatments 91% said it should be used in Medicare coverage decisions 91% said it should be used in Medicare coverage decisions 75% said it should be used by private health plans 75% said it should be used by private health plans

June 5, 2007 Academy Health Annual Research Meeting12 Findings  Prior to the workshop, the median difference in the CEA ratios of treatments participants said they would cover and those they said they would not cover was $37,000  After the workshop, the median difference grew to $247,000 (p,0.001 using non-parametric statistics)  Thus, people were more likely, after receiving CE information, to cover more cost-effective treatments and choose not to cover less cost- effective treatments.

June 5, 2007 Academy Health Annual Research Meeting13

June 5, 2007 Academy Health Annual Research Meeting14 Findings  So then why don’t we use CEA?  Discussion and post-workshop survey identify key barriers among these organizations  In post-workshop survey, the following were identified as important barriers by at least two- thirds of respondents: Disconnect between long-term perspective of CEA and short-term perspective of most decision makers Disconnect between long-term perspective of CEA and short-term perspective of most decision makers The risk of litigation The risk of litigation Commercial sponsorship of CEA studies of products Commercial sponsorship of CEA studies of products

June 5, 2007 Academy Health Annual Research Meeting15 Findings  Other barriers emerging in qualitative analysis of discussion: Americans will find cost unacceptable as a basis for coverage decisions (a special problem for health plans vis a vis market share) Americans will find cost unacceptable as a basis for coverage decisions (a special problem for health plans vis a vis market share) No single private sector entity can “go it alone” – someone, e.g. Medicare, has to take the lead on this major societal issue No single private sector entity can “go it alone” – someone, e.g. Medicare, has to take the lead on this major societal issue

June 5, 2007 Academy Health Annual Research Meeting16 Implications  Decision makers may be more open than we think to using CEA  Our other research indicates that the public can also (through similar workshops) learn enough about CEA to understand it, discuss it, recognize its problems and limits, but then respond like the decision makers to CEA information

June 5, 2007 Academy Health Annual Research Meeting17 Implications  The term “cost-effectiveness” is widely misused (e.g. for cheap or cost-saving)  It also carries the “baggage” of the term “rationing”  Action is needed to: Increase understanding of CEA among the public and decision makers? Increase understanding of CEA among the public and decision makers? Create an environment in which it is “safe” to use CEA as ONE input to coverage decisions? Create an environment in which it is “safe” to use CEA as ONE input to coverage decisions? Encourage the Medicare program to examine the advantages of CEA as a cost-constraining device that may not have as many deleterious effects on access and quality as other options? Encourage the Medicare program to examine the advantages of CEA as a cost-constraining device that may not have as many deleterious effects on access and quality as other options?