Health Economic Evaluations - Literature review Example

Health Economics Task Health Economics Introduction Health economics refers to the allocation of health and health care resources to different populations, especially considering the scarcity of these services. Health economics is vital in the management of evidence based social and health care because it provides the data necessary to undertake medical interventions on a given individual patient or community. While making considerations of economics, it is important to note the diversities within a population, and how these considerations affect the decision making process of health and social care. This incorporates evaluation of changes in demographics, advances in technology, and changes in consumer demand, and their effects on the scarcity, demand, and choice of health care by individuals. Health economists have to consider the opportunity costs that they incur for preferring one mode of treatment to another, as well as, how this has effects on the equity, effectiveness and efficiency of health care services (Black, Gruen & Wonderling, 2005). A good example is the United Kingdom’s health care system, which makes use of economic evidence such as the NICE system. There exist different methods of analysing health economics and its impact on the state of the economy using means such as the cost effectiveness analysis. This gives much importance to the critical appraisal of health economic evaluations, such as the guidelines provided by NICE (National Institute for Health and Care Excellence) in the United Kingdom. NICE provides necessary guidelines for appraisal of health economics, especially in relation to methods of technology. For instance, NICE makes use of health economics in developing programs such as technology appraisals and clinical guidelines for referencing. As such, the aim and objective of this assignment is to explore the advantages of using health economics in the management of UK health care system, with a detailed analysis of the best structures to manage costs and efficiency of delivery of health care services (Annemans, 2008). The Critique and Implication for Health and Social Care Decision-Making This research paper evaluates the cost effectiveness of a manual based coping strategy program aimed at promoting and maintaining mental health of carers within a family for people diagnosed with dementia. This is a pragmatic randomised controlled trial, the START – strategies for relatives study. This program undergoes an intensive appraisal through the various tools of appraisal majorly used in undertaking an economic evaluation. The critique analysis attempts to find answers to the three main questions about the program, which are the likelihood of using the economic valuation in question, or how to assess and compare costs and consequences involved, as well as, whether the results documented help in purchasing necessary services for the locals within the community. The relevance of this topic is that it will enable health economists to develop cost-effective measures of dealing with people who have dementia, as well as, empowering their families and relatives to become more proactive towards their social care and health care provision. this enables the health care providers to meet the needs and demands of their patients (Earl-Slater, 1999). The START framework is the one in use in this analysis as an intervention program for patients of dementia. This program works as an additional perspective to the normal treatment of the patient, which is also cost effective when placed in comparison with usual treatment alone. The analysis method used is the cost effectiveness analysis that the analysts and researchers nest it within a pragmatic randomised controlled trial. The research paper uses three participants who have mental health problems, and a single patient diagnosed with neurological dementia at an outpatient clinic service within Essex and London in the United Kingdom, where the research conducted its study (Giraldes, 2000). The major participants of this program were the family carers of people suffering from dementia, and the intervention process entailed an eight-session, manual based, coping intervention delivered by psychology graduates under strict supervision to the family carers of these patients of dementia. This strategies for relatives study intervention seeked to establish the effect of the program in addition to normal treatment and then make a comparison with the usual treatment of the disease on its own. Health economics came into play whereby there was measurement of these programs from both the health care and social care perspective. The analysis of these results was in line with the total score of the Hospital Anxiety and Depression Scale (HADS-T) of the affective symptoms and Quality Adjusted Life Years (QALYs) in the analyses of cost effectiveness from a baseline of over eight months (Henderson, 2011). Critical Appraisal A- Is the economic evaluation likely to be usable? This health economic analysis took the perspective of the health service evaluation (UK/NHS). As such, it is an appropriate study given its settings within outpatient clinics located in the United Kingdom. The study involved a few participants but majorly the caregivers of persons who were suffering from dementia. The potential limitations, however, of this study was its lack of consideration of the broader perspective of dementia cases in the society, such as the other persons dealing with people suffering from dementia, such as the public, employers, and other concerned bodies. Nonetheless, the research considered various measures and perspectives in accounting for the new START program by incorporating QALYs measurements in its analysis (Jones, 2007). The START program in treating cases of dementia in Essex and London in the UK reach out to exploit the cost effectiveness of empowering family caregivers of these patients in the process of caring for their patients. this research employed the cost effectiveness analysis nested within a pragmatic randomised trial in determining how best the inclusion if the START program works in the reduction of both health care and social care costs of patients suffering with dementia. The assessment also utilised other evaluation and appraisal measures such as the HADS-T and QALY (Lorna & Virginia, 2011). B- How were consequences and cost assessed and compared? The study provides clear information on how the research took place at two different settings in Essex and London. The researchers used two groups of participants, and subjected each group to different methods of intervention, such as the one with START program and the other one without start program. Two Hundred and Sixty participants recruited for the study and researchers randomised 173 of them through the START intervention, while the remainder of 87 undertook treatment according to the normal procedures. The scores showed impressive results especially those of mean HADS-T scores, which were comparatively low in the intervention group as opposed to the group undergoing the normal process of treatment. This was the case for the entire period of the evaluation, which lasted for eight months. The mean differences of these outcomes were -1.79(95% CI – 3.32 to – 0.33), which was a positive indicator that better outcomes associated with the use of the START program (McPake, Normand & Smith, 2013). Furthermore, there was a slightly significant progress in health improvement relating to the Quality of Life as evident in the various measurements takes by QALYs (0.03 (-0.01 to 0.08)). The costs were equally no different between the usual treatment group and the intervention group, which provided (£252 (−28 to 565) higher for START group). As such, the calculations of cost effectiveness suggested that START provided a significant chance, towering over 99% for being the most reliable cost effective measure to the treatment of dementia as compared to the usual treatment alone. This means that using the start program enabled the patients to get well better as opposed to other normal treatment procedures. This cost effectiveness also considers the QALY threshold of £30 000 that each patient was willing to pay, as well as, the consideration of the high probability of the cost effectiveness on the HADS-T measure (Neun & Santere, 2009). Cost Effectiveness The economic research question of this whole study was the viability of the START intervention, such as the manual based coping, cost effectiveness. The measurement of this cost effectiveness was against its inclusion as an additional treatment procedure to carer givers of patients with dementia. this program was to reduce the symptoms of both depression and anxiety among family carers, as well as, enhancing the Quality of Life QALYs related to health and well being over the period of eight months which the program lasted. The study conducted a cost effectiveness analysis on the new intervention to treatment of dementia from both a health care, as well as, a social care perspective. Examination of randomized health and social care costs accrued over the eight months period were necessary to establish the variance in utilization of both models of treatment. This examination run alongside the HADS-T score at the eighth month assessment, in relation to the quality adjusted life years (QALYs for over eight months). All these measures and scores provide that the START treatment program was more effective in dealing with these cases as opposed to the normal treatment procedures (Annemans, 2008). Statistical Analysis A statistical analysis in this case provides the experts of health economics with the necessary data for the proper decision making process. The study undertook an in-depth analysis of the QALY and HADS-t differences existing between the two groups, that with START intervention and that without any form of intervention and following normal treatment procedures. this analysis also considered the differences in costs of health and social care between normal treatment groups and START treatment groups by incorporating the regression of total cost allocated on treatment, age and sex of carer, centre, baseline costs, carer burden (ZARIT), and care recipient neuropsychiatric symptoms (NPI). Through the linear model of multilevel regression to account for the clustering of therapists in the intervention arm, as well as, the repeated measures for each individual, the study was able to deduce that the START program bore more significance in recuperation of patients as opposed to the normal manner of treatment. The costs were much lower, manageable, and affordable to most of the patients involved in this study (Klarman, 1970). Sensitivity Analysis The study also explored sensitivity analysis among the family carers of patients with dementia, with the first analysis adjusted to check out the significant baseline differences found on both demographic, as well as, clinical predictors of missing values. These results showed close similarity to other primary analyses previously carried out on the same topic. The mean of the ICER values were £5452 for every additional QALY and £107 for every one-point difference recorded in the HADS-T score. There is a curve of cost effectiveness acceptability with QALY as the outcome measures (Black, Gruen & Wonderling, 2005). C- Will the results help in purchasing for local people? This paper is very important when it comes to the decision making process of the health and social care policy within its field of specialization. It provides clear incite on the best way to intervene in treating dementia patients in a manner that is cost effective, as well as, guaranteed for faster recuperation and recovery of patients. It also ensures that the costs used in treatment are much lower comparing to the normal procedures and processes of medical interventions on dementia. As such, the results of this study advocate for the full utilization of the START program in the local populations of England such as the major towns of Essex and London. In addition, the costs are also very manageable as compared to the income capabilities of the local communities who may want to try it out. Therefore, health economics experts can use this study to vouch for the use of START program in treating patients suffering from dementia and as such, bring to control the amount of cash spend on treating the disease. This makes the entire case manageable for both the government and the patients involved (Earl-Slater, 1999). Conclusion In conclusion, it is important to note that the start intervention program is the most cost effective measure in dementia treatment when added to the usual care and treatment of the disease. This is in relation to measurement of costs from both the health care system and the social care system perspectives, as well as, whenever these measurements take stock of the affective symptoms, and, those of a health related quality of life over the period of eight months (Giraldes, 2000). Furthermore, the manual based coping intervention of START, added to normal treatment provides an even greater cost effective result as compared to the normal treatment procedures that physicians may undertake on its own. The scores are comparative and pleasant for all users of the new model and perspective of management, especially the symptoms of family carers, and the carer based QALYs. The application of this method in care treatment and management of patients with dementia is therefore advocated for, and guaranteed for success in accordance to the exemplary results showcased by this study (Henderson, 2011). Appendices Fig 1 Cost effectiveness acceptability curve: START intervention (manual based coping strategy therapy) versus treatment as usual; health and social care perspective, with effectiveness measured on the Hospital Anxiety and Depression Scale total score (HADS-T), over eight months Fig 2 Cost effectiveness acceptability curve: START intervention versus treatment as usual; health and social care perspective, with effectiveness measured in quality adjusted life year (QALY) gain, over eight months, following sensitivity analysis adjusting for baseline imbalances References Annemans, L. (2008). Health Economics for Non-Economists: An Introduction to the Concepts, Methods and Pitfalls of Health Economic Evaluations. Waltham, MA: Academia Press, 2008 Black, N., Gruen, R. & Wonderling, D. (2005). Introduction to Health Economics. New York: Mcgraw-Hill International. Earl-Slater, A. (1999). Dictionary of Health Economics. Milton Keynes: Radcliffe Publishing. Giraldes, M. (2000). Health Economics: A Practical View. Berlin: Waxmann Verlag. Henderson, J. (2011). Health Economics and Policy (With Economic Applications). Stamford, Connecticut: Cengage Learning. Jones, A. (2007). Applied Econometrics For Health Economists: A Practical Guide. Milton Keynes: Radcliffe Publishing. Klarman, H. (1970). Empirical Studies in Health Economics: Proceedings. Baltimore: Johns Hopkins Press. Lorna, G. & Virginia, W. (2011). Introduction to Health Economics. New York: Mcgraw-Hill International. McPake, B., Normand, B. & Smith, S. (2013). Health Economics: An International Perspective. London: Routledge. Neun, S. & Santere, R. (2009). Health Economics: Theory, Insights, and Industry Studies. Stamford, Connecticut: Cengage Learning. Read More