Inefficiencies in health care: what is the value of information and value of implementation, and how to decide about health innovations and implementation strategies?

Abstract

In budget constrained health systems, policy decisions to adopt, reimburse or issuing guidance on health innovations (e.g., new pharmaceuticals, medical devices or surgical procedures) are increasingly informed by economic evaluations. Nonetheless, evidence on the cost-effectiveness of innovation in health care often remains uncertain. Moreover, the appropriate use of innovations by health professionals and/or patients does not always follow automatically or immediately. As a result, the inefficiencies in health care may be considerable, with health and resources forgone. Decision makers should consider whether it is worthwhile to collect additional (economic) evidence and/or invest in strategies, like educational activities or incentives, to promote the implementation of cost-effective innovations in health care. Decision making about the (active) implementation and further evaluation of health innovations is preferably based on an integral analysis of the efficiency of policy options to improve health care, particularly as research and implementation costs may vary with health innovations.

In this seminar, various decision analytic methods for informing decision making about innovation in health care, investments in active implementation and research funding are discussed. More specifically, a cost-effectiveness framework is presented for establishing both the value of information and that of implementation, and the differences are explained between a] the common incremental or sequential approach to analysis of the separate but related decisions on health innovations and those on implementation strategies, and b] the integral approach. Next to this, the methodological challenges in integral analysis of policy options to improve health care will be addressed. The use and practicality of the decision analytic methods will be demonstrated by applying them to inform health policy in metastatic hormone-refractory prostate cancer in the United Kingdom.