Greg L. Stoddart

Bio: Greg L. Stoddart is an academic researcher from McMaster University. The author has contributed to research in topics: Health policy & Health care. The author has an hindex of 27, co-authored 90 publications receiving 19779 citations. Previous affiliations of Greg L. Stoddart include Canadian Institute for Advanced Research & Université de Montréal.

Methods for the Economic Evaluation of Health Care Programmes

Abstract: The purpose of economic evaluation is to inform decisions intended to improve healthcare. The new edition of Methods for the Economic Evaluation of Health Care Programmes equips the reader with the necessary tools and understanding required to undertake evaluations by providing an outline of key principles and a 'tool kit' based on the authors' own experiences of undertaking economic evaluations. Building on the strength of the previous edition, the accessible writing style ensures the text is key reading for the non-expert reader, as no prior knowledge of economics is required. The book employs a critical appraisal framework, which is useful both to researchers conducting studies and to decision-makers assessing them. Practical examples are provided throughout to aid learning and understanding. The book discusses the analytical and policy challenges that face health systems in seeking to allocate resources efficiently and fairly. New chapters include 'Principles of economic evaluation' and 'Making decisions in healthcare' which introduces the reader to core issues and questions about resource allocation, and provides an understanding of the fundamental principles which guide decision making. A key part of evidence-based decision making is the analysis of all the relevant evidence to make informed decisions and policy. The new chapter 'Identifying, synthesising and analysing evidence' highlights the importance of systematic review, and how and why these methods are used. As methods of analysis continue to develop, the chapter on 'Characterising, reporting and interpreting uncertainty' introduces the reader to recent methods of analysis and why characterizing uncertainty matters for health care decisions. The fourth edition of Methods for the Economic Evaluation of Health Care Programmes has been thoroughly revised and updated, making it essential reading for anyone commissioning, undertaking, or using economic evaluations in health care, including health service professionals, health economists, and health care decision makers.

Methods for the Economic Evaluation of Health Care Programmes, Second Edition

Abstract: We are witnessing a paradigm shift in the way medicine is practiced, taught, and evaluated. It was relatively recently that medicine knew no limits. New diagnostic procedures led to more medical and surgical procedures and to greater expense. It was assumed that patients would be the recipient of these advances. However, the uncontrolled costs of medical care and the poor documentation of patient benefit ushered in a new era of cost conscientiousness. Now, there is a need to show that medicine produces value for money. As a result, new methodologies such as cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis have become commonplace in medical journals. This has created a need to revise medical education and postgraduate training in order to accommodate new methodologies and new controversies. Within the last few years, several influential publications have emerged. Perhaps the most important of these is the book Cost-Effectiveness in Health and Medicine edited by Martha Gold and colleagues.1 This book summarizes the consensus of an expert panel convened to review cost-effectiveness analysis in health care. The Gold book covers the theory but does not teach the methods. Methods for the Economic Evaluation of Health Care Programmes by Michael Drummond and colleagues offers specific, step-by-step methodologies for conducting economic evaluations. This is the second edition of a book originally published in 1987. During the ten years between editions, there were very substantial advances in theory and methods for economic evaluations of health care programs. The revised edition brings the text up to date. Methods for the Economic Evaluation of Health Care Programmes arises from the teaching of health economics at McMaster University. The McMaster Centre for Health Economics and Policy Analysis is internationally regarded as a focal point for economic evaluations of health care. Among other advances, researchers at the Centre have produced a widely used methodology, known as the Health Utilities Index, for estimating the cost/utility of health programs. The book was originally developed for a course at McMaster and for a workshop offered by the McMaster faculty. The second edition adds one new author (Bernie O’Brien) who has more recently joined the McMaster faculty. The second edition also introduces substantial changes in the chapters on cost-effectiveness, cost-utility, and cost-benefit analysis. These are important improvements because of the profound methodological developments in these areas. In addition, the second edition includes new chapters on collection and analysis of data and on the presentation and use of data. These new chapters add discussion on the pros and cons of economic evaluations and on some of the difficulties in the interpretation of economic data. In addition, the second edition includes many more boxes and illustrations to facilitate the interpretation of the text. Perhaps the greatest contribution of the book is the very detailed presentation of cost/utility analysis. It is now common to offer discussions of the cost to produce a year of life adjusted for life quality. This is known as a quality adjusted life year (QALY). There are a variety of different methods for estimating QALYs. Nevertheless, QALYs estimated using different methods are often found in the same comparison or “league” table. This book goes into considerable detail in how QALYs are estimated and describes some of the methodological issues and problems in estimating these outcomes. Unlike other texts, the book provides systematic stepby-step instruction in how both costs and health benefits can be estimated. In summary, the role of health economics is becoming firmly established in the evaluation of health care programs. In combination with Gold and colleagues’ book,1 which provides a detailed theoretical discussion of economic analysis, Methods for the Economic Evaluation of Health Care Programmes offers systematic training in the application of economic methodologies. This book can serve as a basic text for students hoping to understand the complex methodologies of economic evaluation. In addition, the book is a handy reference for advanced practitioners of economic analysis.

What Is Population Health

Abstract: Population health is a relatively new term that has not yet been precisely defined. Is it a concept of health or a field of study of health determinants? We propose that the definition be “the health outcomes of a group of individuals, including the distribution of such outcomes within the group,” and we argue that the field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. We present a rationale for this definition and note its differentiation from public health, health promotion, and social epidemiology. We invite critiques and discussion that may lead to some consensus on this emerging concept.

Producing Health, Consuming Health Care

Abstract: In this paper we propose a conplexe framework to present a wide range of relationships among the determinants of health.

Revisiting the behavioral model and access to medical care: does it matter?

Abstract: The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.

Effectiveness and efficiency of guideline dissemination and implementation strategies

Abstract: OBJECTIVES: To undertake a systematic review of the effectiveness and costs of different guideline development, dissemination and implementation strategies. To estimate the resource implications of these strategies. To develop a framework for deciding when it is efficient to develop and introduce clinical guidelines. DATA SOURCES: MEDLINE, Healthstar, Cochrane Controlled Trial Register, EMBASE, SIGLE and the specialised register of the Cochrane Effective Practice and Organisation of Care (EPOC) group. REVIEW METHODS: Single estimates of dichotomous process variables were derived for each study comparison based upon the primary end-point or the median measure across several reported end-points. Separate analyses were undertaken for comparisons of different types of intervention. The study also explored whether the effects of multifaceted interventions increased with the number of intervention components. Studies reporting economic data were also critically appraised. A survey to estimate the feasibility and likely resource requirements of guideline dissemination and implementation strategies in UK settings was carried out with key informants from primary and secondary care. RESULTS: In total, 235 studies reporting 309 comparisons met the inclusion criteria; of these 73% of comparisons evaluated multifaceted interventions, although the maximum number of replications of a specific multifaceted intervention was 11 comparisons. Overall, the majority of comparisons reporting dichotomous process data observed improvements in care; however, there was considerable variation in the observed effects both within and across interventions. Commonly evaluated single interventions were reminders, dissemination of educational materials, and audit and feedback. There were 23 comparisons of multifaceted interventions involving educational outreach. The majority of interventions observed modest to moderate improvements in care. No relationship was found between the number of component interventions and the effects of multifaceted interventions. Only 29.4% of comparisons reported any economic data. The majority of studies only reported costs of treatment; only 25 studies reported data on the costs of guideline development or guideline dissemination and implementation. The majority of studies used process measures for their primary end-point, despite the fact that only three guidelines were explicitly evidence based (and may not have been efficient). Respondents to the key informant survey rarely identified existing budgets to support guideline dissemination and implementation strategies. In general, the respondents thought that only dissemination of educational materials and short (lunchtime) educational meetings were generally feasible within current resources. CONCLUSIONS: There is an imperfect evidence base to support decisions about which guideline dissemination and implementation strategies are likely to be efficient under different circumstances. Decision makers need to use considerable judgement about how best to use the limited resources they have for clinical governance and related activities to maximise population benefits. They need to consider the potential clinical areas for clinical effectiveness activities, the likely benefits and costs required to introduce guidelines and the likely benefits and costs as a result of any changes in provider behaviour. Further research is required to: develop and validate a coherent theoretical framework of health professional and organisational behaviour and behaviour change to inform better the choice of interventions in research and service settings, and to estimate the efficiency of dissemination and implementation strategies in the presence of different barriers and effect modifiers.