Cost effectiveness

About: Cost effectiveness is a research topic. Over the lifetime, 69775 publications have been published within this topic receiving 1531477 citations.

The NICE cost-effectiveness threshold: what it is and what that means.

Abstract: The National Institute for Health and Clinical Excellence (NICE) has been using a cost-effectiveness threshold range between 20,000 pound sterling and 30,000 pound sterling for over 7 years. What the cost-effectiveness threshold represents, what the appropriate level is for NICE to use, and what the other factors are that NICE should consider have all been the subject of much discussion. In this article, we briefly review these questions, provide a critical assessment of NICE's utilization of the incremental cost-effectiveness ratio (ICER) threshold to inform its guidance, and suggest ways in which NICE's utilization of the ICER threshold could be developed to promote the efficient use of health service resources. We conclude that it is feasible and probably desirable to operate an explicit single threshold rather than the current range; the threshold should be seen as a threshold at which 'other' criteria beyond the ICER itself are taken into account; interventions with a large budgetary impact may need to be subject to a lower threshold as they are likely to displace more than the marginal activities; reimbursement at the threshold transfers the full value of an innovation to the manufacturer. Positive decisions above the threshold on the grounds of innovation reduce population health; the value of the threshold should be reconsidered regularly to ensure that it captures the impact of changes in efficiency and budget over time; the use of equity weights to sustain a positive recommendation when the ICER is above the threshold requires knowledge of the equity characteristics of those patients who bear the opportunity cost. Given the barriers to obtaining this knowledge and knowledge about the characteristics of typical beneficiaries of UK NHS care, caution is warranted before accepting claims from special pleaders; uncertainty in the evidence base should not be used to justify a positive recommendation when the ICER is above the threshold. The development of a programme of disinvestment guidance would enable NICE and the NHS to be more confident that the net health benefit of the Technology Appraisal Programme is positive.

Cost-effective control of air quality and greenhouse gases in Europe: Modeling and policy applications

Abstract: Environmental policies in Europe have successfully eliminated the most visible and immediate harmful effects of air pollution in the last decades. However, there is ample and robust scientific evidence that even at present rates Europe's emissions to the atmosphere pose a significant threat to human health, ecosystems and the global climate, though in a less visible and immediate way. As many of the 'low hanging fruits' have been harvested by now, further action will place higher demands on economic resources, especially at a time when resources are strained by an economic crisis. In addition, interactions and interdependencies of the various measures could even lead to counter-productive outcomes of strategies if they are ignored. Integrated assessment models, such as the GAINS (Greenhouse gas - Air pollution Interactions and Synergies) model, have been developed to identify portfolios of measures that improve air quality and reduce greenhouse gas emissions at least cost. Such models bring together scientific knowledge and quality-controlled data on future socio-economic driving forces of emissions, on the technical and economic features of the available emission control options, on the chemical transformation and dispersion of pollutants in the atmosphere, and the resulting impacts on human health and the environment. The GAINS model and its predecessor have been used to inform the key negotiations on air pollution control agreements in Europe during the last two decades. This paper describes the methodological approach of the GAINS model and its components. It presents a recent policy analysis that explores the likely future development of emissions and air quality in Europe in the absence of further policy measures, and assesses the potential and costs for further environmental improvements. To inform the forthcoming negotiations on the revision of the Gothenburg Protocol of the Convention on Long-range Transboundary Air Pollution, the paper discusses the implications of alternative formulations of environmental policy targets on a cost-effective allocation of further mitigation measures.

Clinically important outcomes in low back pain.

Abstract: Four important domains directly related to low back pain are: pain intensity, low-back-pain-specific disability, patient satisfaction with treatment outcome, and work disability. Within each of the domains, different questionnaires have been proposed. This chapter focuses on validated and widely used questionnaires. Details of the background and the measurement properties, and of the minimally clinically important change (MCIC) using these questionnaires, are described. The MCIC can be estimated using various methods and there is no consensus in the literature on what the most appropriate technique is. This chapter focuses primarily on two adequate and frequently used methods for estimating the MCIC. We argue that the MCIC should not be considered as a fixed value and that the MCIC values presented in this chapter are used as indications. For patients with subacute or chronic low back pain, the MCIC for pain on a visual analogue scale (VAS) should at least be 20 mm and for acute low back pain it seems reasonable to suggest that the MCIC should at least be at the level of approximately 35 mm. If a numerical rating scale (NRS) is used it seems reasonable to suggest that the MCIC should at least be 3.5 and 2.5 for patients with acute and chronic low back pain, respectively. For functional disability as measured with the Roland Disability Questionnaire it seems reasonable that the MCIC should at least be 3.5 points, whereas an MCIC of at least 10 points when the Oswestry Disability Index is used. For global perceived effect, we argue that the MCIC is most appropriately defined in terms of at least 'much improved' or 'very satisfied', instead of including 'slightly improved'. Finally, we argue that, from the point of view of cost effectiveness, every day of earlier return to work is important. The exact value for the MCIC can be determined, taking into account the aim of the measurement, the initial scores, the target population and the method used to assess MCIC.

Mergers and the Performance of the Acquiring Firm.

Abstract: Do mergers provide real benefits to acquiring firms? If not. as empirical studies completed mostly in the field of finance conclude, then why do firms continue to merge? If mergers do provide real benefits, as the literature of industrial organizations and strategic management suggest, then why haven't the empirical studies found any evidence of real benefits? By integrating the conclusions on mergers from the above three disciplines, these questions are addressed.