1. Stratified cost-effectiveness analysis: a framework for establishing efficient limited use criteria
- Author
-
Martin Buxton, Douglas Coyle, and Bernie J. O'Brien
- Subjects
Technology Assessment, Biomedical ,Opportunity cost ,Cost-Benefit Analysis ,Myocardial Infarction ,MEDLINE ,Efficiency ,Risk Assessment ,Health Services Accessibility ,Fibrinolytic Agents ,Health care ,Economics ,Humans ,Streptokinase ,Thrombolytic Therapy ,health care economics and organizations ,Reimbursement ,Actuarial science ,business.industry ,Patient Selection ,Health Policy ,Cost-effectiveness analysis ,Quality-adjusted life year ,Tissue Plasminogen Activator ,Insurance, Health, Reimbursement ,Economic evaluation ,Guideline Adherence ,Quality-Adjusted Life Years ,Risk assessment ,business ,Models, Econometric - Abstract
The cost-effectiveness of new health care technologies is conditional upon who receives what therapy and under what circumstances. Understanding this heterogeneity in cost-effectiveness, health care payers often limit reimbursement of therapies to a more restrictive sub-group of patients than that indicated in a product's licensing. Such limits may be based upon clinical or demographic criteria that are prognostic of costs, outcomes or both. However, there is little guidance on how to estimate and interpret stratified cost-effectiveness analysis. In this paper we present a framework for estimating the benefits from stratification that permits consideration of both the opportunity cost resulting from a lack of adherence with criteria and the efficiency loss associated with incorporating equity concerns.
- Published
- 2003