Incorporating Resource Constraints in Health Economic Evaluations: Overview and Methodological Considerations.

It is well known that healthcare resource constraints influence the capacity to deliver care, affecting both the costs and outcomes of medical interventions. If these constraints are not adequately accounted for in economic evaluations, there may be a lack of understanding regarding the full impact of implementing health technologies, leading to decisions being made with suboptimal information. This paper offers an overview of the types of healthcare resource constraints and their potential effects, and introduces a framework grounded in operations research and health economics principles, outlining the methodological considerations for incorporating resource constraints into economic evaluations. Drawing from a literature review and advisory group feedback, three categories of resource constraints were identified: single-use resource constraints, reusable resource constraints and patient throughput constraints. The proposed framework outlines a comprehensive set of steps necessary for effectively incorporating constraints into health economic evaluations and details specific approaches and methodological considerations for each stage to ensure a more accurate and realistic assessment of health interventions. This paper also aims to raise awareness among payers and decision-makers with regards to the limitations of technology evaluations in a resource-constrained health system. Specifically, it suggests that health technology assessment agencies ought to offer guidance on incorporating constraints into the submissions they receive. Moreover, it advocates for a more comprehensive economic evaluation in economic assessments to fully capture an intervention's value.
Competing Interests: Declarations. Conflict of Interest: Henrique Duarte and Roelien Postema are full-time employees of Putnam Associates. Gerardo Machnicki is a full-time employee of F. Hoffmann-La Roche, Ltd. Praveen Thokala is the director of PT Health Economics Ltd and has been paid consultancy fees by Putnam/PHMR Ltd to advise on this study. He has also performed paid consultancy in the past with IQVIA, RTI-HS, Roche, Pfizer, Daiichi Sankyo, Exact Sciences, Abbvie, Novo Nordisk and Novartis. Stuart Wright is supported by a Wellcome Trust Early Career Award (226922/Z/23/Z). Don Husereau has received fees from F. Hoffmann-La Roche AG for unrelated projects. Isabelle Durand-Zaleski reports fees for speaking engagements and advisory board participation from BMS, Janssen, MSD, NovoNordisk and Hoffmann-La Roche AG for unrelated projects. Peter Lindgren reports institutional grants from AstraZeneca, Biogen, Jansen, MSD and Novartis and fees for speaking engagements and advisory board participation from Astellas, AstraZeneca, Biomarin, Daiichi Sankyo, Jansen, MSD, NovoNordisk, SOBI, Takeda and Vertex. Lou Garrison has received consulting and speaking fees unrelated to this project from Pfizer, Novartis Gene Therapy, Roche, Merck, J&J and BioMarin. Ethics Approval: Not applicable. Consent to Participate: Not applicable. Consent for Publication (From Patients/Participants): Not applicable.
(© 2024. The Author(s).)