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Publications

Below are showcased publications produced by NOAHE Members. If you are a NOAHE member and would like to have your publication featured on our website and on social media affiliated with the Network, please contact us at noahe@ihe.ca; Not a NOAHE member? Sign up here!

Please note: The publications listed on this page serve to showcase the work of our individual members only, and do not necessarily represent the views of the Network of Alberta Health Economists (NOAHE), NOAHE Members, and/or NOAHE funders.


Determinants of Change in the Cost-effectiveness Threshold

The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency of existing interventions, and the development of new health technologies. We consider the anticipated direction of impact that would affect the threshold following a change in each of these determinants. Where the health care system is technically efficient, an increase in the health care budget unambiguously raises the threshold, whereas an increase in the demand for existing, non-marginal health interventions unambiguously lowers the threshold. Improvements in the technical efficiency of existing interventions may raise or lower the threshold, depending on the cause of the improvement in efficiency, whether the intervention is already funded, and, if so, whether it is marginal. New technologies may also raise or lower the threshold, depending on whether the new technology is a substitute for an existing technology and, again, whether the existing technology is marginal. Our analysis permits health economists and decision makers to assess if and in what direction the threshold may change over time. This matters, as threshold changes impact the cost-effectiveness of interventions that require decisions now but have costs and effects that fall in future periods.

Authors: Mike Paulden, MSc; James O’Mahony, PhD; Christopher McCabe, PhD

Publication Date: August 2016

Determinants of Change in the Cost-effectiveness Threshold

The Economic Contribution of Industry-Sponsored Pharmaceutical Clinical Trials

In pharmaceutical clinical trials, industrial sponsors pay for study drugs and related healthcare services. We conducted a study to determine industry’s economic contribution of these trials to the Alberta healthcare system.

Author: Dat T Tran, Ilke Akpinar, Richard Fedorak, Egon Jonsson, John Mackey, Lawrence Richer, Philip Jacobs

Publication Date: 2017

The Economic Contribution of Industry-Sponsored Pharmaceutical Clinical Trials

Economic Evaluation of Interventions for Children with Neurodevelopmental Disorders: Opportunities and Challenges

Economic evaluation is a tool used to inform decision makers on the efficiency of comparative healthcare interventions and inform resource allocation decisions. There is a growing need for the use of economic evaluations to assess the value of interventions for children with neurodevelopmental disorders (NDDs), a population that has increasing demands for healthcare services. Unfortunately, few evaluations have been conducted to date, perhaps stemming from challenges in applying existing economic evaluation methodologies in this heterogeneous population. Opportunities exist to innovate methods to address key challenges in conducting economic evaluations of interventions for children with NDDs. In this paper, we discuss important considerations and highlight areas for future work. This includes the paucity of appropriate instruments for measuring outcomes meaningful to children with NDDs and their families, difficulties in the measurement of costs due to service utilization in a wide variety of sectors, complexities in the measurement of caregiver and family effects and considerations in estimating long-term productivity costs. Innovation and application of evaluation approaches in these areas will help inform decisions around whether the resources currently spent on interventions for children with NDDs represent good value for money, or whether greater benefits for children could be generated by spending money in other ways.

Author: Ramesh Lamsal, Jennifer D. Zwicker

Publication Date: Aug 2017

Economic Evaluation of Interventions for Children with Neurodevelopmental Disorders: Opportunities and Challenges

Bill C-30: who wins and who loses in Canada’s pharmaceutical patent battles?

Following lengthy negotiations with the European Union (EU), Canada enacted Bill C-30 to implement the ‘Comprehensive Economic and Trade Agreement’ in 2016 [1]. A particularly important part of that legislation involved the treatment of pharmaceutical exclusivity and the process of litigation between patentees and generic firms. This paper reviews the likely impact of C-30 and its accompanying regulations on the pharmaceutical marketplace in Canada. There are two key changes, with other downstream effects. First, Canada has now implemented a system of ‘Certificates of Supplementary Protection’ (CSPs) that will provide for effective patent extension of up to 2 years for one qualifying patent for each product. Second, the legal process for generic firms to enter the market has been simplified.

Author:Aidan Hollis

Publication Date: Oct 2017

https://doi.org/10.1080/13543776.2018.1388780

The Healthcare Cost Burden of Acute Myocardial Infarction in Alberta, Canada

Little is known about the cost burden of acute myocardial infarction (AMI) on healthcare systems. Accordingly, we examined the long-term trends of healthcare costs for AMI in the province of Alberta, Canada.

Authors: Dat T. Tran, Arto Ohinmaa, Nguyen X. Thanh, Robert C. Welsh, Padma Kaul

Publication Date: Nov 2017

The Healthcare Cost Burden of Acute Myocardial Infarction in Alberta, Canada

Association of body mass index (BMI) and percent body fat among BMI-defined non-obese middle-aged individuals: Insights from a population-based Canadian sample.

Middle-aged individuals classified as normal by BMI may be overweight/obese based on measures of %BF. These individuals may be at risk for chronic diseases, but would not be identified as such based on their BMI classification. Quantifying %BF in this group could inform targeted strategies for disease prevention.

Authors: Collins KH, Sharif B, Sanmartin C, Reimer RA, Herzog W, Chin R, Marshall DA.

Publication Date: Mar 2017

Association of body mass index (BMI) and percent body fat among BMI-defined non-obese middle-aged individuals: Insights from a population-based Canadian sample.

Show Drugs Work Before Selling Them

Regulation makes economic sense, argue Douglas Sipp, Christopher McCabe and John E. J. Rasko.

Authors: Douglas Sipp, Christopher McCabe & John E. J. Rasko

Publication Date: Mar 2017

Show drugs work before selling them

"Part of the Team": Mapping the outcomes of training patients for new roles in health research and planning.

A patient research internship (Patient and Community Engagement Research program-PaCER) was created to support a provincial commitment by Alberta Health Services' Strategic Clinical Networks™ to find new ways to engage patients in a new interdisciplinary organization to support evidence-informed improvements in clinical outcomes across the health system.

Authors:Shklarov S, Marshall D, Wasylak T, Marlett N

Publication Date:Jun 2017

"Part of the Team": Mapping the outcomes of training patients for new roles in health research and planning.

A Comparison of Four Software Programs for Implementing Decision Analytic Cost-Effectiveness Models

The volume and technical complexity of both academic and commercial research using decision analytic modelling has increased rapidly over the last two decades. The range of software programs used for their implementation has also increased, but it remains true that a small number of programs account for the vast majority of cost-effectiveness modelling work. We report a comparison of four software programs: TreeAge Pro, Microsoft Excel, R and MATLAB. Our focus is on software commonly used for building Markov models and decision trees to conduct cohort simulations, given their predominance in the published literature around cost-effectiveness modelling. Our comparison uses three qualitative criteria as proposed by Eddy et al.: “transparency and validation”, “learning curve” and “capability”. In addition, we introduce the quantitative criterion of processing speed. We also consider the cost of each program to academic users and commercial users. We rank the programs based on each of these criteria. We find that, whilst Microsoft Excel and TreeAge Pro are good programs for educational purposes and for producing the types of analyses typically required by health technology assessment agencies, the efficiency and transparency advantages of programming languages such as MATLAB and R become increasingly valuable when more complex analyses are required.

Authors:Chase Hollman, Mike Paulden, Petros Pechlivanoglou, Christopher McCabe

Publication date: May 2017

A Comparison of Four Software Programs for Implementing Decision Analytic Cost-Effectiveness Models

Stem cells and beta cell replacement therapy: a prospective health technology assessment study

Although current beta cell replacement therapy is effective in stabilizing glycemic control in highly selected patients with refractory type 1 diabetes, many hurdles are inherent to this and other donor-based transplantation methods. One solution could be moving to stem cell-derived transplant tissue. This study investigates a novel stem cell-derived graft and implant technology and explores the circumstances of its cost-effectiveness compared to intensive insulin therapy. 

Author: Klemens Wallner

Publication date: Mar 2017

Stem cells and beta cell replacement therapy: a prospective health technology assessment study

The price of whole genome sequencing may be decreasing, but who will be sequenced?

Since whole-genome sequencing (WGS) information can have positive and negative personal utility for individuals, we examined predictors of willingness to pay (WTP) for WGS. Patients & methods: We surveyed two independent populations: adult patients (n = 203) and college seniors (n = 980). Ordinal logistic regression models were used to characterize the relationship between predictors and WTP. Results: Sex, age, education, income, genomic knowledge and knowing someone who had genetic testing or having had genetic testing done personally were associated with significantly higher WTP for WGS. After controlling for income and education, males were willing to pay more for WGS than females. Conclusion: Differences in WTP may impact equity, coverage, affordability and access, and should be anticipated by public dialog about related health policy.

Authors: Deborah Marshall,Karen V MacDonald, Jill Oliver Robinson, Kathryn A Phillips

Publication date: March 2017

The price of whole genome sequencing may be decreasing, but who will be sequenced?

Achieving optimal technology use: A proposed model for health technology reassessment

Healthcare providers, managers and policy-makers in many jurisdictions are focused on a common goal: optimizing value and quality of care provided to their citizens within a resource envelope. Health technology reassessment is a structured, evidence-based assessment of the clinical, social, ethical and economic effects of a technology currently used in the healthcare system to inform optimal use of that technology in comparison with its alternatives. There are, however, few practical experiences with health technology reassessment and, as such, a nascent theoretical and methodological base. Health technology reassessment is a key strategy to achieve optimal healthcare resource utilization, and establishing a model for health technology reassessment is a required methodological step.

Authors: Lesley JJ Soril, Gail MacKean, Tom W Noseworthy, Laura E Leggett, and Fiona M Clement

Publication date: April 2017

Achieving optimal technology use: A proposed model for health technology reassessment

Value of Information Analysis of Multiparameter Tests for Chemotherapy in Early Breast Cancer: The OPTIMA-Prelim Trial

Precision medicine is heralded as offering more effective treatments to smaller targeted patient populations. In breast cancer, adjuvant chemotherapy is standard for patients considered as high-risk after surgery. Molecular tests may identify patients who can safely avoid chemotherapy. The objective of this paper is to use economic analysis before a large-scale clinical trial of molecular testing to confirm the value of the trial and help prioritize between candidate tests as randomized comparators.

Authors: Peter S. Hall PhD, Alison Smith Msc, Claire Hulme PhD, Armando Vargas-Palacios PhD, Andreas Makris MD, Luke Hughes-Davies PhD, Janet A. Dunn PhD, John M.S. Bartlett PhD, David A. Cameron MD, Andrea Marshall PhD, Amy Campbell BA, Iain R. Macpherson PhD, Dan Rea PhD, Adele Francis PhD, Helena Earl PhD, Adrienne Morgan PhD, Robert C. Stein PhD, Christopher McCabe PhD

Publication date:July 2017

Value of Information Analysis of Multiparameter Tests for Chemotherapy in Early Breast Cancer: The OPTIMA-Prelim Trial

Innovative Funding Models: Kidney Care Policy Options for the Future – Summary Report

The current approach to funding kidney care in Alberta is not aligned with the strategic goals for Alberta Kidney Care, and the Alberta Health Services Kidney – Strategic Clinical Network, including increasing the appropriate use of home dialysis, non-dialysis supportive care, and kidney transplantation. Current funding models, which are not well aligned with these priorities, should be re-examined to ensure consistent access to the most effective evidencebased therapies across the province, and to capitalize on new technologies that would support patients and caregivers for greater independence.

Publication date: November 2015

Download Innovative Funding Models: Kidney Care Policy Options for the Future – Summary Report

The State of Health Economics in Alberta: A Review of Need, Capacity, and Action

Cost is a critical element in almost all public or private decisions regarding health care and human services. While cost as “opportunity cost” is straightforward on a conceptual level, making the concept operational, quantifying costs and integrating such information into decision analysis is a continuing challenge. An IHE conference, “On the State of the Art in Costing Methods: Workshop” was held January 21-22, 2015.

Publication date: May 2015

Download The State of Health Economics in Alberta A Review of Need Capacity and Action

On the State of the Art in Costing Methods: Summary Report

The discipline of health economics can provide important information that can form part of the evidence-base for health care decision-making in Alberta. This work, conducted by the Institute for Health Economics (IHE) and the University of Calgary (Health Economics group), was performed to better understand the unmet educational needs and health economics products that could support people in the province, and to determine the current capacity for conducting health economics in Alberta

Publication date: April 2015

Download On the State of the Art in Costing Methods: Summary Report