PharmacoEconomics

, Volume 23, Issue 11, pp 1075–1082 | Cite as

Economic evaluations of healthcare programmes and decision making

The influence of economic evaluations on different healthcare decision-making levels
  • Marieke E. van Velden
  • Johan L. Severens
  • Annoesjka Novak
Review Article

Abstract

Given the potential role of economic information in healthcare decision making, it is of interest to assess its influence on decisions at a national or regional level (macro level), at a healthcare facility level (meso level) and at the healthcare provider level (micro level). This literature review summarises 36 empirical studies that examined the influence of economic evaluations on these three healthcare decision-making levels.

Economic evaluations are considered useful and important; however, their direct influence on decision making (instrumental use) is moderate, especially at the macro and micro levels. A major influence was observed at the meso level, leading to the conclusion that economic evaluations have the most pronounced influence on decision making within healthcare organisations. However, unexpectedly, our literature search did not reveal an empirical study analysing the considerable influence of economic evaluations on decisions by the National Institute of Health and Clinical Excellence in the UK.

Our findings indicate that results of economic evaluations cannot be considered the dominant decision criterion for healthcare decision makers at either the macro, meso or micro levels. Enlightenment use (where scientific evidence provides a background of information, ideas and concepts that affect the way policy makers view problems and solutions) of economic evaluations in decision making remains to be proven.

Notes

Acknowledgements

The authors received funding from Roche Nederland BV, Woerden, The Netherlands. AN is employed by Roche Nederland BV. No other potential conflicts exist. The views expressed in this paper are those of the authors only and they accept full responsibility for any errors or inaccuracies that may remain.

References

  1. 1.
    Hoffmann C, Graf von der Schulenberg J-M. The use of economic evaluation studies in health care decision-making: sum-mary-report. In: Graf von der Schulenberg JM, editor. The influence of economic evaluation studies on health care deci-sion-making. Amsterdam: IOS Press, 2000: 3–16Google Scholar
  2. 2.
    Tarn TYH, Smith MD. Pharmacoeconomic guidelines around the world. ISPOR Connections [online]. Available from URL: http://www.ispor.org/PEguidelines/index.asp [Accessed 2004 Aug]Google Scholar
  3. 3.
    Drummond M, Dubois D, Grattini L, et al. Current trends in the use of pharmacoeconomics and outcomes research in Europe. Value Health 1999; 2 (5): 323–32PubMedCrossRefGoogle Scholar
  4. 4.
    Severens JL. Economic evaluation in health care: the usefulness of research guidelines. Eur J Obstet Gynecol Reprod Bio J 2001 Jan; 94 (1): 5–7CrossRefGoogle Scholar
  5. 5.
    Johannesson M. Economic evaluation of drugs and its potential uses in policy making. Pharmacoeconomics 1995; 8 (3): 190–8PubMedCrossRefGoogle Scholar
  6. 6.
    Hoogerwerf A. Hfst. 1 Beleid, processen en effecten. In: Hoogerwerf A, Herweijer M, editors. Overheidsbeleid. Fen inleiding in de beleidswetenschap. Samsom: Alphen aan den Rijn, 1998: 17–35Google Scholar
  7. 7.
    Weiss CH. Chapter 3: The haphazard connection: social science and public policy. Int J Educ Res 1995; 23 (2): 137–50CrossRefGoogle Scholar
  8. 8.
    Dunn WN. Public policy analysis: an introduction. Upper Saddle River (NJ): Pearson Prentice Hall, 2004Google Scholar
  9. 9.
    Anell A, Svarvar P. Pharmacoeconomics and clinical practice guidelines: a survey of attitudes in Swedish formulary committees. Pharmacoeconomics 2000 Feb; 17 (2): 175–85PubMedCrossRefGoogle Scholar
  10. 10.
    Bloom BS. Use of formal benefit/cost evaluations in health system decision making. Am J Manag Care 2004 May; 10 (5): 329–35PubMedGoogle Scholar
  11. 11.
    Drummond M, Cooke J, Walley T. Economic evaluation under managed competition: evidence from the UK. Soc Sci Med 1997 Aug; 45 (4): 583–95PubMedCrossRefGoogle Scholar
  12. 12.
    Duthie T, Trueman P, Chancellor J, et al. Research into the use of health economics in decision making in the United Kingdom: phase II. Is health economics ‘for good or evil’? Health Policy 1999 Jan; 46 (2): 143–57PubMedCrossRefGoogle Scholar
  13. 13.
    Hoffmann C, Stoykova BA, Nixon J, et al. Do health-care decision makers find economic evaluations useful? The find-ings of focus group research in UK health authorities. Value Health 2002; 5 (2): 71–9PubMedCrossRefGoogle Scholar
  14. 14.
    Luce BR, Brown RE. The use of technology assessment by hospitals, health maintenance organizations, and third-party payers in the United States. Int J Technol Assess Health Care 1995; 11 (1): 79–92PubMedCrossRefGoogle Scholar
  15. 15.
    Martin DK, Pater JL, Singer PA. Priority-setting decisions for new cancer drugs: a qualitative case study. Lancet 2001 Nov 17; 358 (9294): 1676–81PubMedCrossRefGoogle Scholar
  16. 16.
    Nuijten MJC, et al. Health care reform in six Central European countries. Eur J Health Econ 2003 Dec; 4 (4): 286–91PubMedCrossRefGoogle Scholar
  17. 17.
    PausJenssen AM, Singer PA, Detsky AS. Ontario’s formulary committee: how recommendations are made. Pharmacoeconomics 2003; 21 (4): 285–94PubMedCrossRefGoogle Scholar
  18. 18.
    Ross J, The use of economic evaluation in health care: Australian decision makers’ perceptions. Health Policy 1995 Feb; 31 (2): 103–10PubMedCrossRefGoogle Scholar
  19. 19.
    Singer PA, Martin DK, Giacomini M, et al. Priority setting for new technologies in medicine: qualitative case study. BMJ 2000 Nov; 321 (7272): 1316–8PubMedCrossRefGoogle Scholar
  20. 20.
    Steiner CA, Powe NR, Anderson GF, et al. Technology coverage decisions by health care plans and considerations by medical directors. Med Care 1997 May; 35 (5): 472–89PubMedCrossRefGoogle Scholar
  21. 21.
    Walley T, Barton S, Cooke J, et al. Economic evaluations of drug therapy: attitudes of primary care prescribing advisors in Great Britain. Health Policy 1997 Jul; 41 (1): 61–72PubMedCrossRefGoogle Scholar
  22. 22.
    Weatherly H, Drummond M, Smith D. Using evidence in the development of local health policies: some evidence from the United Kingdom. Int J Technol Assess Health Care 2002; 18 (4): 771–81PubMedCrossRefGoogle Scholar
  23. 23.
    West R, Borden EK, Collet JP, et al. “Cost-effectiveness” estimates results in flawed decision-making in listing drugs for reimbursement. Can J Public Health 2002 Nov-Dec; 93 (6): 421–5PubMedGoogle Scholar
  24. 24.
    Zwart-van Rijkom JE, Leufkens HG, Busschbach JJ, et al. Differences in attitudes, knowledge and use of economic eval-uations in decision-making in the Netherlands: the Dutch results from the EUROMET Project. Pharmacoeconomics 2000 Aug; 18 (2): 149–60PubMedCrossRefGoogle Scholar
  25. 25.
    Cox E, Motheral B, Griffis D. ISPOR Fifth Annual International Meeting Contributed Presentation Abstracts: relevance of pharmacoeconomics and health outcomes information to health care decision-makers in the United States (PDH23) [abstract]. Value Health 2000; 3 (2): 162CrossRefGoogle Scholar
  26. 26.
    Evans C, Dukes EM, Crawford B. The role of pharmacoeconomic information in the formulary decisionmaking process. J Manag Care Pharm 2000 Mar-Apr; 6 (2): 108, 113-4, 117-8, 121Google Scholar
  27. 27.
    Grabowski H, Mullins CD. Pharmacy benefit management, cost-effectiveness analysis and drug formulary decisions. Soc Sci Med 1997 Aug; 45 (4): 535–44PubMedCrossRefGoogle Scholar
  28. 28.
    Grizzle AJ, Motheral B, Garrity B, et al. ISPOR Fifth Annual International Meeting Contributed Presentation Abstracts: a qualitative assessment of managed care decision-maker’s views and use of pharmacoeconomic information (PDH25). Value Health 2000; 3 (2): 162–3CrossRefGoogle Scholar
  29. 29.
    Grizzle AJ, Olson BM, Motheral BR, et al. Therapeutic value? Who decides? Pharmaceutical Executive 2000 Nov; 20 (11): 84–90Google Scholar
  30. 30.
    Jenkings KN, Barber N. What constitutes evidence in hospital new drug decision making? Soc Sci Med 2004 May; 58 (9): 1757–66PubMedCrossRefGoogle Scholar
  31. 31.
    Luce BR, Lyles CA, Rentz AM. The view from managed care pharmacy. Health Aff 1996 Winter; 15 (4): 168–76CrossRefGoogle Scholar
  32. 32.
    Lyles A, Luce BR, Rentz AM. Managed care pharmacy, socio-economic assessments and drug adoption decisions. Soc Sci Med 1997 Aug; 45 (4): 511–21PubMedCrossRefGoogle Scholar
  33. 33.
    Martin DK, et al. Priority setting in a hospital drug formulary: a qualitative case study and evaluation. Health Policy 2003 Dec; 66 (3): 295–303PubMedCrossRefGoogle Scholar
  34. 34.
    Martin DK, Hollenberg D, MacRae S, et al. Role of pharmacoeconomics in drug benefit decision-making: results of a survey. Formulary 2000 May; 35: 412–21Google Scholar
  35. 35.
    Odedina FT, Sullivan J, Nash R, et al. Use of pharmacoeconomic data in making hospital formulary decisions. Am J Health Syst Pharm 2002 Aug; 59 (15): 1441–4PubMedGoogle Scholar
  36. 36.
    Sloan FA, Whetten-Goldstein K, Wilson A. Hospital pharmacy decisions, cost containment, and the use of cost-effectiveness analysis. Soc Sci Med 1997 Aug; 45 (4): 523–33PubMedCrossRefGoogle Scholar
  37. 37.
    Spath HM, Charavel M, Morelle M, et al. A qualitative approach to the use of economic data in the selection of medicines for hospital formularies: a French survey. Pharm World Sci 2003 Dec; 25 (6): 269–75PubMedCrossRefGoogle Scholar
  38. 38.
    Steiner CA, Powe NR, Anderson GF, et al. The review process used by US health care plans to evaluate new medical technology for coverage. J Gen Intern Med 1996 May; 11 (5): 294–302PubMedCrossRefGoogle Scholar
  39. 39.
    Brody B, Wray N, Bame S, et al. The impact of economic considerations on clinical decision-making: the case of thrombolytic therapy. Med Care 1991 Sep; 29 (9): 899–910PubMedCrossRefGoogle Scholar
  40. 40.
    Erkan D, Yazici Y, Harrison MJ, et al. Physician treatment preferences in rheumatoid arthritis of differing disease severity and activity: the impact of cost on first-line therapy. Arthritis Rheum 2002 Jun 15; 47 (3): 285–90PubMedCrossRefGoogle Scholar
  41. 41.
    Ginsberg ME, Kravitz RL, Sandberg WA. A survey of physician attitudes and practices concerning cost-effectiveness in patient care. West J Med 2000 Dec; 173 (6): 390–4CrossRefGoogle Scholar
  42. 42.
    Kangis P, Van der Geer L. Pharmaco-economic information and its effect on prescriptions. J Manag Med 1996; 10 (5): 66–74PubMedCrossRefGoogle Scholar
  43. 43.
    Ubel PA, Jepson C, Baron J, et al. The influence of costeffectiveness information on physicians’ cancer screening recommendations. Soc Sci Med 2003 Apr; 56 (8): 1727–36PubMedCrossRefGoogle Scholar
  44. 44.
    Wu O, Knill-Jones R, Wilson P, et al. The impact of economic information on medical decision making in primary care. J Eval Clin Pract 2004 Aug; 10 (3): 407–11PubMedCrossRefGoogle Scholar
  45. 45.
    Sub DC, Okpara IR, Agnese WB, et al. Application of pharmacoeconomics to formulary decision making in managed care organizations. Am J Manag Care 2002; 8 (2): 161–9Google Scholar
  46. 46.
    Ubel P. Physicians’ duties in an era of cost containment: advocacy or betrayal? [letter]. JAMA 1999 Nov; 282 (17): 1675PubMedCrossRefGoogle Scholar
  47. 47.
    Devlin N, Parkin D. Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Econ 2004; 13: 437–52PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  • Marieke E. van Velden
    • 1
  • Johan L. Severens
    • 1
    • 2
  • Annoesjka Novak
    • 3
  1. 1.Department of Health Organization Policy and EconomicsUniversity MaastrichtMaastrichtThe Netherlands
  2. 2.Department of Clinical Epidemiology and Medical Technology AssessmentUniversity Hospital MaastrichtMaastrichtThe Netherlands
  3. 3.Roche Nederland BVWoerdenThe Netherlands

Personalised recommendations