Value of information analysis in healthcare: a review of principles and applications

Background:

Economic evaluations are increasingly utilized to inform decisions in healthcare; however, decisions remain uncertain when they are not based on adequate evidence. Value of information (VOI) analysis has been proposed as a systematic approach to measure decision uncertainty and assess whether there is sufficient evidence to support new technologies.

Scope:

The objective of this paper is to review the principles and applications of VOI analysis in healthcare. Relevant databases were systematically searched to identify VOI articles. The findings from the selected articles were summarized and narratively presented.

Findings:

Various VOI methods have been developed and applied to inform decision-making, optimally designing research studies and setting research priorities. However, the application of this approach in healthcare remains limited due to technical and policy challenges.

Conclusion:

There is a need to create more awareness about VOI analysis, simplify its current methods, and align them with the needs of decision-making organizations.     

Retaining volunteers for the cause: Hope and pride associated with cause-related charity events in cancer control

Special charity events are an important source of revenue for non-profit organisations in cancer control yet volunteering is declining and turnover is high. Experiences at cause-related events may influence retention, particularly emotions connected to the cause and ceremonies which honour cancer survivors and remember loved ones. We explore the degree to which emotions associated with cause-related volunteering and collective action in the literature are felt in response to Relay For Life and what emotions predict three indicators of retention: intention to return for future events, satisfaction with volunteering, and organisational commitment. Volunteers (n = 410) completed a cross-sectional survey at Relay For Life events in Queensland, Australia. Multiple regression analyses examined whether emotions associated with events predicted each indicator of retention, adjusting for number of years spent volunteering for events. Sixty-two percent reported an intention to return the following year. The most commonly reported event-related emotions were hope, pride, and empathy (62–69%). Intention to return, satisfaction, and commitment were each significantly predicted by hope and pride. The findings suggest special charity events in cancer control could retain volunteers by fostering pride and hope (e.g., for a cancer free future); however, future prospective research which examines the mechanisms of these relationships is warranted.     

The economics of the private finance initiative

This article outlines and assesses the private finance initiativein the UK. The initiative has been slow to develop despite pressurefrom governments (anxious to limit the PSBR) and several revampsto facilitate the PFI approach. Within a PFI project there arebeneficial incentives to avoid cost over-runs but not to reducecosts where they affect long-run services. These incentivesand the limits to their effectiveness are explored. Such contractsrequire the transfer of risk from the public to the privatesector. the role and pricing of risk in the PFI is analysed.It is argued that the PFI does not value risk correctly andthat the value for money test is biased against private-sectorprovision. Policy implications are discussed, including a revampof the value for money test and the introduction of explicitassessment of the impact of potential renegotiation and othercontractual difficulties.     

Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study

Background: The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival.

Methods: This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results.

Results: During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY.

Conclusion: Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.     

Cost and time savings from a rapid access model of care using transient elastography to screen and triage patients with chronic Hepatitis C infection

Background:

Treatment uptake amongst patients with chronic Hepatitis C virus (HCV) in Australia is relatively low. New approaches to assessment have the potential to reduce public waiting lists, improve access to treatment, and to reduce healthcare costs.

Aim:

To describe the costs to the public hospital system and waiting time associated with a novel integrated rapid access to assessment and treatment (RAAT) model of care that utilizes Transient Elastography (TE) as a specialist outpatient-based approach for a streamlined assessment of patients with chronic HCV, compared to conventional outpatient management with liver biopsy (LB).

Methods:

Time from first medical review to treatment plan and costs associated with detection of fibrosis were recorded for patients receiving RAAT during a 3-month period, and for a similar historical cohort managed conventionally with LB. Costs related to medical and multidisciplinary team reviews and the TE/LB test itself were included.

Results:

Patients receiving RAAT had lower costs (n?=?27, median AU$2716) and shorter time to treatment (median?=?194 days) than for conventional management (n?=?13, median $5005, 420 days; p?Conclusions:

Based on real world audit data, this evaluation suggests TE, used as part of a new RAAT model of care, is cost saving to the health system in the short-term and reduces waiting times. The analysis reported here was intended to assess the costs related to detection of fibrosis, and is limited by the small sample size and potential selection bias. Future research should undertake a full economic evaluation at a whole of service level, to consider a more comprehensive and longer-term assessment of the costs and benefits associated with HCV management.     

Financial improvement planning in local governments in Southern Africa,with special reference to Zambia

Continuing decentralisation in most developing countries increases pressure on local governments to manage more functions and services and larger budgets. In this context, financial improvement planning (FIP) is a strategy that can be used by local governments wishing to improve or ‘fine‐tune’ their financial performance, and especially by those facing serious financial difficulties. This article examines the application of FIP in the town of Kitwe, Zambia, which faces financial difficulties within a national decentralisation framework characterised by several policy and fiscal deficiencies. The article covers how an FIP framework was developed, undertaken and the resultant interventions structured. Implications regarding the role, design and techniques of FIP in local governments within a decentralisation policy framework are elaborated upon. Effective decentralisation in southern African countries requires local governments to undertake sound financial management. In turn, this requires local governments to embrace challenging local policy processes. Development of FIP techniques, and strengthening local capacity and policy to support them in local governments, should be ingredients of any country's decentralisation programme.