Objective. —To develop consensus-based recommendations for the conduct of cost-effectiveness analysis (CEA). This article, the second in a 3-part series, describes the basis for recommendations constituting the reference case analysis, the set of practices developed to guide CEAs that inform societal resource allocation decisions, and the content of these recommendations. Participants. —The Panel on Cost-Effectiveness in Health and Medicine, a nonfederal panel with expertise in CEA, clinical medicine, ethics, and health outcomes measurement, was convened by the US Public Health Service (PHS). Evidence. —The panel reviewed the theoretical foundations of CEA, current practices, and alternative methods used in analyses. Recommendations were developed on the basis of theory where possible, but tempered by ethical and pragmatic considerations, as well as the needs of users. Consensus Process. —The panel developed recommendations through 21/2 years of discussions. Comments on preliminary drafts prepared by panel working groups were solicited from federal government methodologists, health agency officials, and academic methodologists. Conclusions. —The panel's methodological recommendations address (1) components belonging in the numerator and denominator of a cost-effectiveness (C/E) ratio; (2) measuring resource use in the numerator of a C/E ratio; (3) valuing health consequences in the denominator of a C/E ratio; (4) estimating effectiveness of interventions; (5) incorporating time preference and discounting; and (6) handling uncertainty. Recommendations are subject to the "rule of reason," balancing the burden engendered by a practice with its importance to a study. If researchers follow a standard set of methods in CEA, the quality and comparability of studies, and their ultimate utility, can be much improved.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=409634&pdfFileName=jama_276_15_031.pdf

Recommendations of the Panel on Cost-effectiveness in Health and Medicine.

Summary
This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27).

/pdf/osteoporosis-in-the-european-union-medical-management-5gi5e439ck.pdf

Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA).

Importance Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. Objective To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. Design In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. Findings The concept of a “reference case” and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an “impact inventory,” which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses. Conclusions and Relevance The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

/pdf/recommendations-for-conduct-methodological-practices-and-52cls1pxlr.pdf

Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine

EORTC QLQ-C30 Scoring Manual

This is the latest updated volume in a well-established series bringing together information from a variety of sources to estimate national unit costs for a wide range of health and social care services. This report consists of tables for more than 130 types of service which, as well as providing the most detailed and comprehensive information possible, also quotes sources and assumptions so users can adapt the information for their own purposes. This year we have included a guest editorial on ‘Big Data’: increasing productivity while reducing costs in health and social care and three short articles on The cost of integrated care; Shared lives – improving understanding of the costs of family-based support and the costs of providing a group intervention to people with dementia and their family carers:SHIELD: RYCT & CSP intervention costs (Remembering Yesterday Caring Today and Carer Support Programme). There are also several new schema providing the costs of: advocacy for people with learning disabilities; a hospice rapid response service; the early years classroom management programme; residential parenting assessments; independent review officers; time banks; dentists and care home costs for people with dementia. The 2014 edition is also available in full, free of charge, at the PSSRU website www.pssru.ac.uk/unit-costs/2014/ as an Acrobat file.

Unit Costs of Health and Social Care 2014

Public health in the Victorian era had two major concerns: housing conditions and sanitation. These two elements were seen as crucial in improving the health status of the population. This Victorian notion of public health was, therefore, centred upon the prevention rather than cure ofdisease. The early years ofthis century saw a narrowing of this Victorian vision with an increased emphasis on personal hygiene and individual action in the prevention of disease. Thus there was a shift in the focus of disease prevention from society as a whole to its individual members. This influenced the role of public health doctors whose administrative responsibilities were increasing as they assumed responsibility for municipal hospitals. These administrative and preventive roles brought public health doctors into conflict with family doctors about the scope and objectives of public health. The establishment of the National Health Service, which left public health doctors in charge ofa range of community services, only served to heighten the conflicts within the medical profession about the role of public health within a socialised medical system. The emergence of the social work profession created a further area of conflict. Although the 1974 reorganisation of the NHS created the specialty of community medicine, thereby providing public health doctors with a career structure similar to that of other specialties within medicine, the role of the new specialty was emasculated. The fledgling specialty was given the responsibility for planning and coordinating health care delivery within local areas. However, few resources were provided and little opportunity has arisen for the new community physicians to implement their plans. The provision of a medicalised career structure has done little to overcome the negative image of community medicine within the rest of the medical profession. This book presents an historical view of the development of one branch of the medical profession. Using archival material supplemented by interviews with community physicians, Jane Lewis shows how 'public health' and 'preventive medicine' have been supplanted as the central concern of medicine by curative and acute specialties. The much vaunted current policies of prevention and community care have not served to rescue community medicine from languishing in obscurity. This book provides an interesting account of the development of the medical 355

https://jech.bmj.com/content/jech/41/4/355.2.full.pdf

S H Wilson

Papers

Methods for the economic evaluation of health care programmes