In a budget constrained healthcare system the decision to invest in strategies to
improve the implementation of cost-effective technologies must be made alongside decisions
regarding investment in the technologies themselves and investment in further research. This
paper presents a single, unified framework that simultaneously addresses the problem of
allocating funds between these separate but linked activities.
The framework presents a simple 4 state world where both information and
implementation can be either at the current level or ‘perfect’. Through this framework it is
possible to determine the maximum return to further research and an upper bound on the
value of adopting implementation strategies. The framework is illustrated through case
studies of health care technologies selected from those previously considered by the UK
National Institute for Health and Clinical Excellence (NICE).
Through the case studies, several key factors that influence the expected values of
perfect information and perfect implementation are identified. These factors include the
maximum acceptable cost-effectiveness ratio, the level of uncertainty surrounding the
adoption decision, the expected net benefits associated with the technologies, the current
level of implementation and the size of the eligible population.
Previous methods for valuing implementation strategies have confused the
value of research and the value of implementation. This framework demonstrates that the
value of information and the value of implementation can be examined separately but
simultaneously in a single framework. This can usefully inform policy decisions about
investment in healthcare services, further research and adopting implementation strategies
which are likely to differ between technologies.
|CHE Research Paper
|Centre for Health Economics
© 2005 Elisabeth Fenwick, Karl Claxton, Mark Sculpher. The full text of this report can be viewed free of charge from the Centre for Health Economics web site at: http://www.york.ac.uk/inst/che/pdf/rp5.pdf
- value of information analysis
- value of implementation
- healthcare decision-making
- Bayesian analysis