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Implications of Nonmarginal Budgetary Impacts in Health Technology Assessment: A Conceptual Model
- Source :
- Value in Health, 22(8), 891-897. ELSEVIER SCIENCE INC
- Publication Year :
- 2019
-
Abstract
- Objectives This paper introduces a framework with which to conceptualize the decision-making process in health technology assessment for new interventions with high budgetary impacts. In such circumstances, the use of a single threshold based on the marginal productivity of the healthcare system is inappropriate. The implications of this for potential partial implementation, horizontal equity, and pharmaceutical pricing are illustrated using this framework. Results Under the condition of perfect divisibility and given an objective of maximizing health, a large budgetary impact of a new treatment may imply that optimal implementation is partial rather than full, even at a given incremental cost-effectiveness ratio that would nevertheless mean the decision to accept the treatment in full would not lead to a net reduction in health. In a one-shot price-setting game, this seems to give rise to potential horizontal equity concerns. When the assumption of fixity of the incremental cost-effectiveness ratio (arising from the assumed exogeneity of the manufacturer’s price) is relaxed, it can be shown that the threat of partial implementation may be sufficient to give rise to an incremental cost-effectiveness ratio at which cost the entire potential population is treated, maximizing health at an increased level, and with no contravention of the horizontal equity principle.
- Subjects :
- Budgets
Contravention
Prescription Drugs
Technology Assessment, Biomedical
Cost effectiveness
Cost-Benefit Analysis
media_common.quotation_subject
Decision Making
Population
State Medicine
OPPORTUNITY
Microeconomics
COST-EFFECTIVENESS
03 medical and health sciences
equity
0302 clinical medicine
Economics
Marginal product
Humans
030212 general & internal medicine
Endogeneity
education
media_common
education.field_of_study
030503 health policy & services
Health Policy
Public Health, Environmental and Occupational Health
Equity (finance)
pharmaceutical price regulation
Health technology
CARE
FRAMEWORK
United Kingdom
Models, Economic
Costs and Cost Analysis
Conceptual model
Quality-Adjusted Life Years
0305 other medical science
Subjects
Details
- Language :
- English
- ISSN :
- 10983015
- Database :
- OpenAIRE
- Journal :
- Value in Health, 22(8), 891-897. ELSEVIER SCIENCE INC
- Accession number :
- edsair.doi.dedup.....b649ff606fdd4bcb192096b2760d50f6