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Type: Journal article
Title: Informing disinvestment through cost-effectiveness modelling: is lack of data a surmountable barrier?
Author: Karnon, J.
Carlton, J.
Czoski-Murray, C.
Smith, K.
Citation: Applied Health Economics and Health Policy, 2009; 7(1):1-9
Publisher: Adis International Ltd.
Issue Date: 2009
ISSN: 1175-5652
Statement of
Jonathan Karnon, Jill Carlton, Carolyn Czoski-Murray and Kevin Smith
Abstract: The mandatory nature of recommendations made by the National Institute for Health and Clinical Excellence (NICE) in the UK has highlighted inherent difficulties in the process of disinvestment in existing technologies to fund NICE-approved technologies. A lack of evidence on candidate technologies means that the process of disinvestment is subject to greater uncertainty than the investment process, and inefficiencies may occur as a result of the inverse evidence law. This article describes a potential disinvestment scenario and the options for the decision maker, including the conduct of value of information analyses. To illustrate the scenario, an economic evaluation of a disinvestment candidate (screening for amblyopia and strabismus) is presented. Only very limited data were available. The reference case analysis found that screening is not cost effective at currently accepted values of a QALY. However, a small utility decrement due to unilateral vision loss reduced the incremental cost per QALY gained, with screening expected to be extremely cost effective. The discussion highlights the specific options to be considered by decision makers in light of the model-based evaluation. It is shown that the evaluation provides useful information to guide the disinvestment decision, providing a range of focused options with respect to the decision and the decision-making process. A combination of explicit model-based evaluation, and pragmatic and generalizable approaches to interpreting uncertainty in the decision-making process is proposed, which should enable informed decisions around the disinvestment of technologies with weak evidence bases.
Keywords: Humans; Amblyopia; Strabismus; Vision Screening; Models, Economic; Quality-Adjusted Life Years; Biomedical Technology; Child, Preschool; Cost-Benefit Analysis; Investments; Decision Making, Organizational; Organizational Objectives; United Kingdom
Rights: © 2009 Adis Data Information BV. All rights reserved.
RMID: 0020092932
DOI: 10.2165/00148365-200907010-00001
Appears in Collections:Public Health publications

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