Objectives To assess whether recently-proposed alternatives to the quality-adjusted life year (QALY), intended to address concerns about discrimination, are suitable for informing resource allocation decisions. Methods We consider two alternatives to the QALY: the Health Years in Total (HYT), recently proposed by Basu et al., and the Equal Value of Life Years Gained (evLYG),…
| Aaron J Trachtenberg, Amity Quinn, Braden Manns, Brenda Hemmelgarn, Flora Au, Kerry McBrien, Marcello Tonelli, Sepideh Souri, Elissa Rennert-May, Liam Manns, Nikita Arora, Paul Ronksley, Yewande Ogundeji
Physician payment models are perceived to be an important strategy for improving health, access, quality, and the value of health care. Evidence is predominantly from primary care, and little is known regarding whether specialists respond similarly. We conducted a systematic review to synthesize evidence on the impact of specialist physician payment models across the domains of…
| Amity Quinn, Braden Manns, Brenda Hemmelgarn, Flora Au, Marcello Tonelli, Peter Faris, Aaron J Trachtenberg, Jianguo Zhang, Scott Klarenbach, Robert G. Weaver
Health care payers are interested in policy-level interventions to increase peritoneal dialysis use in end-stage renal disease. We examined whether increases in physician remuneration for peritoneal dialysis were associated with greater peritoneal dialysis use.
Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born…
Although probabilistic analysis has become the accepted standard for decision analytic cost-effectiveness models, deterministic one-way sensitivity analysis continues to be used to meet the need of decision makers to understand the impact that changing the value taken by one specific parameter has on the results of the analysis. The value of a probabilistic form of one-way sensitivity…
Enzalutamide (Enza) is an effective treatment for metastatic castrate-resistant prostate cancer (mCPRC). However, Enza is not cost-effective (CE) at willingness to pay (WTP) thresholds from $0-$125 000/quality adjusted life years (QALYs) and is therefore a strain on valuable health care dollars. Metformin (Met) is inexpensive (~$8.00/month) and is thought to improve prostate cancer…
To examine the association between individual-level deprivation and health-related quality of life (HRQL) in the general population.
The federal Advisory Panel on Healthcare Innovation noted the importance of innovation in health care and that most health care systems lack the ability to scale and spread innovation. Some health systems have created system-wide clinical networks that identify priorities, explore solutions and implement strategies to improve care and outcomes. Early evaluations suggest that clinical…
| Alun Edwards, Amity Quinn, Braden Manns, Brenda Hemmelgarn, Flora Au, Kerry McBrien, Marcello Tonelli, Peter Faris, Peter Senior, Robert G. Weaver, Zhihai Ma
Question Is a specialist physician payment model associated with visit frequency, quality of care, and costs for people with chronic disease? Findings In this population-based cohort study that included a propensity-score matched cohort of 31?898 adults with diabetes or chronic kidney disease seen by 489 physicians, there was no statistical evidence of a difference…
| Jane Nixon, Sarah Brown, Isabelle Smith, Elizabeth McGinnis, Armando Vargas-Palacios, E Andrea Nelson, Julia Brown, Susanne Coleman, Howard Collier, Catherine Fernandez, Rachael Gilberts, Valerie Henderson, Christopher McCabe, Delia Muir, Claudia Rutherford, Nikki Stubbs, Benjamin Thorpe, Klemens Wallner, Kay Walker, Lyn Wilson, Claire Hulme
Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients.
Health Technology Assessment (HTA) has always sought to incorporate the evidence of all patients affected in the decision-making process. While health system budgets could increase to cover costs of new technologies, the relevant patients are those benefitting from access to the technology being appraised. More recently, with health system budgets effectively fixed, costs of new…
The authors aimed to determine the cost effectiveness of initiating treatment early in the disease course (within 2 years of CD diagnosis) vs later in the disease course (more than 2 years after diagnosis). To do so, the authors constructed a Markov model of a hypothetical cohort of patients with CD in Canada to simulate disease progression after initiation of infliximab or adalimumab…
| Helena Earl, Louise Hiller, Anne-Laure Vallier, Shrushma Loi, Karen McAdam, Luke Hughes-Davies, Adrian Harnett, Mei-Lin Ah-See, Richard Simcock, Daniel Rea, Sanjay Raj, Pamela Woodings, Mark Harries, Donna Howe, Kerry Raynes, Helen Higgins, Maggie Wilcox, Chris Plummer, Janine Mansi, Ioannis Gounaris, Betania Mahler–Araujo, Elena Provenzano, Anita Chhabra, Jean Abraham, Carlos Caldas, Peter Hall, Christopher McCabe, Claire Hulme, David Miles, Andrew Wardley, David Cameron, Janet Dunn
The authors aimed to investigate whether 6-month adjuvant trastuzumab treatment is non-inferior to the standard 12-month treatment regarding disease-free survival.
| Malek Hannouf, Gregory Zaric, Phillip Blanchette, Christine Brezden-Masley, Mike Paulden, Christopher McCabe, Jacques Raphael, Muriel Brackstone
The authors examined the cost-effectiveness of incorporating these assays into standard practice. A decision model was built to project lifetime clinical and economic consequences of different adjuvant treatment-guiding strategies. The model was parameterized using follow-up data from a secondary analysis of the Anastrozole or Tamoxifen Alone or Combined randomized trial, cost…
The EQ-5D-5 L and the SF-12 are the most commonly used generic measures of health-related quality of life among people with arthritis. However, there is little evidence on the extent to which the individual dimensions and domains of these instruments perform among this population. The objective was to examine the discriminative validity of the EQ-5D-5 L and the SF-12…
| Amity Quinn, Braden Manns, Brenda Hemmelgarn, Flora Au, Marcello Tonelli, Robert G. Weaver, Scott Klarenbach, Helen So
As the adverse clinical outcomes common in patients with chronic kidney disease (CKD) can be prevented or delayed, information on the cost of care across the spectrum of CKD can inform investments in CKD care.
Most pharmaceutical expenditure in Canada is private. In 2017, Canadian provincial, territorial and federal governments were reported to have spent $14.5 billion on pharmaceuticals, accounting for only 43% of total pharmaceutical expenditure.1 A combination of private insurance and patient expenditures in the form of direct payment for pharmaceuticals, deductibles and other…
| Amity Quinn, Alun Edwards, Peter Senior, Kerry McBrien, Brenda Hemmelgarn, Marcello Tonelli, Flora Au, Zhihai Ma, Robert G. Weaver, Braden Manns
Background: As the number of people with chronic diseases increases, understanding the impact of payment model on the types of patients seen by specialists has implications for improving the quality and value of care. We sought to determine if there is an association between the specialist physician payment model and the types of patients seen.
| Christopher McCabe
Comment in: The Inclusion of Spillover Effects in Economic Evaluation: A Public Health Economics Perspective
| Léon Nshimyumukiza, Jean-Alexandre Beaumont, Julie Duplantie, Sylvie Langlois, Julian Little, François Audibert, Christopher McCabe, Jean Gekas, Yves Giguère, Christian Gagné, Daniel Reinharz, François Rousseau
Yearly, 450 000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness…
| Peter Hall, Alison Smith, Claire Hulme, Armando Vargas-Palacios, Andreas Makris, Luke Hughes-Davies, Janet Dunn, John Bartlett, David Cameron, Andrea Marshall, Amy Campbell, Iain Macpherson, Dan Rea, Adele Francis, Helena Earl, Adrienne Morgan, Robert Stein, Christopher McCabe
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…
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…
Regulation makes economic sense, argue Douglas Sipp, Christopher McCabe and John E. J. Rasko.
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…
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…