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CitationsAdd new citationList by: CiterankMap Link[2] We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment
Author: Victoria Charlton, Michael DiStefano, Polly Mitchell, Liz Morrell, Leah Rand, Gabriele Badano, Rachel Baker, Michael Calnan, Kalipso Chalkidou, Anthony Culyer, Daniel Howdon, Dyfrig Hughes, James Lomas, Catherine Max, Christopher McCabe, James F. O'Mahony, Mike Paulden, Zack Pemberton-Whiteley, Annette Rid, Paul Scuffham, Mark Sculpher, Koonal Shah, Albert Weale, Gry Wester Publication date: 27 September 2023 Publication info: Health Economics, Policy and Law (2023), page 1 of 21 Cited by: David Price 2:39 PM 11 December 2023 GMT Citerank: (1) 701020CANMOD – PublicationsPublications by CANMOD Members144B5ACA0 URL: DOI: https://doi.org/10.1017/S1744133123000038
| Excerpt / Summary [Health Economics, Policy and Law, 27 September 2023]
It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny. |
Link[3] Vaccine rollout strategies: The case for vaccinating essential workers early
Author: Nicola Mulberry, Paul Tupper, Erin Kirwin, Christopher McCabe, Caroline Colijn Publication date: 13 October 2021 Publication info: PLOS Glob Public Health 1(10): e0000020 Cited by: David Price 4:52 PM 15 December 2023 GMT
Citerank: (11) 679761Caroline ColijnDr. Caroline Colijn works at the interface of mathematics, evolution, infection and public health, and leads the MAGPIE research group. She joined SFU's Mathematics Department in 2018 as a Canada 150 Research Chair in Mathematics for Infection, Evolution and Public Health. She has broad interests in applications of mathematics to questions in evolution and public health, and was a founding member of Imperial College London's Centre for the Mathematics of Precision Healthcare.10019D3ABAB, 679862Paul TupperProfessor in the Department of Mathematics at Simon Fraser University.10019D3ABAB, 685420Hospitals16289D5D4, 686720Erin KirwinErin Kirwin (she/her) is a Health Economist at the Institute of Health Economics (IHE) in Alberta, Canada. She holds a Bachelor of Arts (Honours) in Economics and International Development Studies from McGill University and a Master of Arts in Economics from the University of Alberta. Prior to joining the IHE, Erin was the Manager of Advanced Analytics at Alberta Health. Erin is a PhD candidate at the University of Manchester.10019D3ABAB, 701020CANMOD – PublicationsPublications by CANMOD Members144B5ACA0, 704041Vaccination859FDEF6, 704045Covid-19859FDEF6, 708794Health economics859FDEF6, 714608Charting a FutureCharting a Future for Emerging Infectious Disease Modelling in Canada – April 2023 [1] 2794CAE1, 715454Workforce impact859FDEF6, 715952Long covid859FDEF6 URL: DOI: https://doi.org/10.1371/journal.pgph.0000020
| Excerpt / Summary [PLOS Global Public Health, 13 October 2021]
In vaccination campaigns against COVID-19, many jurisdictions are using age-based rollout strategies, reflecting the much higher risk of severe outcomes of infection in older groups. In the wake of growing evidence that approved vaccines are effective at preventing not only adverse outcomes, but also infection, we show that such strategies are less effective than strategies that prioritize essential workers. This conclusion holds across numerous outcomes, including cases, hospitalizations, Long COVID (cases with symptoms lasting longer than 28 days), deaths and net monetary benefit. Our analysis holds in regions where the vaccine supply is limited, and rollout is prolonged for several months. In such a setting with a population of 5M, we estimate that vaccinating essential workers sooner prevents over 200,000 infections, over 600 deaths, and produces a net monetary benefit of over $500M. |
Link[4] Logical Inconsistencies in the Health Years in Total and Equal Value of Life-Years Gained
Author: Mike Paulden, Chris Sampson, James F. O’Mahony, Eldon Spackman, Christopher McCabe, Jeff Round, Tristan Snowsill Publication date: 2 December 2023 Publication info: Value in Health, Volume 27, Issue 3, P356-366, March 2024 Cited by: David Price 9:15 PM 4 March 2024 GMT Citerank: (2) 701020CANMOD – PublicationsPublications by CANMOD Members144B5ACA0, 708794Health economics859FDEF6 URL: DOI: https://doi.org/10.1016/j.jval.2023.11.009
| Excerpt / Summary [Value in Health, March 2024]
Objectives: This study aimed 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 2 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), currently used by the Institute for Clinical and Economic Review. For completeness we also consider unweighted life-years (LYs). Using a hypothetical example comparing 3 mutually exclusive treatment options, we consider how calculations are performed under each approach and whether the resulting rankings are logically consistent. We also explore some further challenges that arise from the unique properties of the HYT approach.
Results: The HYT and evLYG approaches can result in logical inconsistencies that do not arise under the QALY or LY approaches. HYT can violate the independence of irrelevant alternatives axiom, whereas the evLYG can produce an unstable ranking of treatment options. HYT have additional issues, including an implausible assumption that the utilities associated with health-related quality of life and LYs are “separable,” and a consideration of “counterfactual” health-related quality of life for patients who are dead.
Conclusions: The HYT and evLYG approaches can result in logically inconsistent decisions. We recommend that decision makers avoid these approaches and that the logical consistency of any approaches proposed in future be thoroughly explored before considering their use in practice. |
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