1 / 94

Learning and Development Session 13:00 – 16:30 Tuesday 17 th April 2018

Learn about economic evaluation techniques in healthcare, NHS budget, cost-benefit analysis, and case examples. Explore cost-effectiveness and cost-utility analysis in healthcare decision-making.

joiner
Download Presentation

Learning and Development Session 13:00 – 16:30 Tuesday 17 th April 2018

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Learning and Development Session 13:00 – 16:30 Tuesday 17th April 2018

  2. Housekeeping

  3. Welcome and introductions • Dr Jen MacDonald - Researcher and ChaiN for SHAIPI Coordinator • Ellie Cutajar - PhD student, GCU • Agi McFarland - Lecturer, GCU • Lauren Blane - PhD student, GCU • Other GCU researchers and PhD students joining during or after the tea/coffee break (Dr Lesley Price, Lucy Gozdzielewska, Prof Paul Flowers, Dr Matt Smith, Jeni Park, Becky Laidlaw, and Fraser Smith)

  4. Update – previously discussed research projects and involvement opportunities Patient perspective of immediate- and long-term HAI impact • Awaiting recruitment of patients via main ECONI project • Decision to recruit patients only, not family members or carers The Listening Lab • Further developing the research idea Y65% - Developing a hand hygiene intervention • Submitted proposal early Jan, but have not progressed to next stage • Useful feedback from funder – back to the drawing board! Factors affecting the implementation and acceptability of hospital screening policies for antimicrobial resistant organisms • Final report, including lay summary, now submitted to funder

  5. SHAIPI The 3 programmes of work • Understanding and managing HAI through studying the bacteria that cause HAI using innovative laboratory techniques – led by the Universities of Glasgow and St. Andrew’s • Using data and computer systems to answer questions, solve problems and make decisions about the management of HAI – led by Strathclyde University and University of Dundee • Improving HAI prevention practices by developing evidence of their effectiveness and promoting the implementation of these practices by healthcare staff, patients and the public – led by Glasgow Caledonian University

  6. Update – future plans • Plan and deliver training to ‘Local Sub-Coordinators’ in WS1 and WS2 • Develop a system to allow better oversight of projects, and thus public involvement opportunities, within WS3 • Implement a broader range of involvement opportunities • Plan and deliver two further Learning and Development sessions

  7. An Introduction to Economic Evaluation Agi McFarland Lecturer Programme Leader, Master of Public Health (MPH) Glasgow Caledonian University School of Health and Life Sciences agi.mcfarland@gcu.ac.uk

  8. Overview • Why economics in healthcare? • Overview of different economic evaluation techniques • Examples from the literature • Examples to work through

  9. Healthcare financing Start of the NHS in 1948 meets the needs of everyone be free at the point of delivery based on clinical need, not ability to pay Budget of £437 million (equivalent to £9 billion in current value) 3.4% of Gross Domestic Product in 1948 Employed 144,000 staff

  10. Advancements Lifestyle choices Population profile

  11. Money, money, money!! • Employs 1.7 million people • Annual budget for 2015/16 of £116.8 billion • Budgetary increase consistently higher than inflation and GDP • Annual 4-5% increase since inception

  12. Not just a British problem

  13. But if you don’t spend the money wisely…

  14. Cost minimisation analysis • Costs of interventions compared • Benefits not measured Clinical example: MUELLER. S., KREBSBACH. LE., 2008. Impact of antimicrobial – impregnated gauze dressing on surgical site infections including methicillin-resistant Staphylococcus aureus infections. American Journal of Infection Control. 36 (9), pp651 – 5. Intervention A Cost Choice – which is cheaper? Cost Intervention B

  15. Cost benefit analysis Cost in £s Cost/outcome • Monetary value given for healthcare: • Inputs (cost) • Outcomes (benefits) • Human capital approach or preferences approach • Monetary returns of investment • Can calculate overall value to society Clinical example: ZHOU., J, MA., X. 2015. Cost-benefit analysis of craniocerebral surgical site infection control in tertiary hospitals in China. The Journal of Infection in Developing Countries. 9 (2), pp182 – 9. Intervention A Outcome in £s Choice – which is cheaper AND offers more monetary benefit? Cost Cost in £s Intervention B Cost/outcome Outcome in £s

  16. Cost effectiveness analysis Cost Cost/outcome • Costs compared with outcomes in natural units expressed over single dimension • Life years gained • Life years saved • Per pain free day • Costs and benefits measured in different units • Examination of both costs and consequences • Comparison of incremental cost effectiveness ratios (ICER) Intervention A Outcome Choice – which is cheaper AND more effective? Cost New intervention B Cost/outcome Outcome

  17. Clinical example: WASSENBERG. MWM, ARDINE DE WIT. G., BONTEN., MJM. 2011. Cost-Effectiveness of Preoperative Screening and Eradication of Staphylococcus aureus Carriage. PLoS One. 6 (5), pp. e14815.

  18. Cost utility analysis Cost Cost/outcome • Costs compared with outcomes expressed in terms of utility (wellbeing) measurement • QALY (calculates additional life years gained weighted by the quality of them) • DALY (calculates years of life lost to disability and years of life lost) • Examination of both costs and consequences • Used when health related quality of life is important outcome • Facilitates comparisons of different interventions using standardised outcome measure Intervention A Wellbeing outcome Choice – which is cheaper AND more effective in terms of wellbeing? Cost Intervention B Cost/outcome Wellbeing outcome

  19. Clinical example : COURVILLE. XF., et al., 2012. Cost-Effectiveness of Preoperative Nasal Mupirocin Treatment in Preventing Surgical Site Infection in Patients Undergoing Total Hip and Knee Arthroplasty: A Cost-Effectiveness Analysis. Infection Control and Hospital Epidemiology. 33 (2), pp. 152 – 9.

  20. What would you decide? £100,000 budget to spend: Bariatric surgery: £6000 per operation Hip replacement: £5459 per operation Dementia support nurse: £21,000 per year

  21. How many people could you help? £100,000 budget to spend: Bariatric surgery: £6000 per operation = 16 operations Hip replacement: £5459 per operation = 18 operations Dementia support nurse: £21,000 per year = 4 nurses to support 4 families

  22. Who is paying? £100,000 budget to spend: Bariatric surgery: • £6000 per operation = 16 operations • Lessen long term burden on health care resource • Lessen burden on social care resource (e.g. housing adaptations) • Increase revenue from income tax (return to work) • Decrease burden on benefits system Hip replacement: • £5459 per operation = 18 operations • Lessen long term burden on health care resource • Lessen burden on social care resource • Decrease burden on benefits system • Increase revenue from income tax (return to work) Dementia support nurse: • £21,000 per year = 4 nurses to support 4 families • Lessen impact on carer

  23. What about quality of life? £100,000 budget to spend: Bariatric surgery: • £6000 per operation = 16 operations • 11 extra quality life years gained (QALYs) Hip replacement: • £5459 per operation = 18 operations • 0.8 extra QALYs gained for the 5 years post treatment Dementia support nurse: • £21,000 per year = 4 nurses to support 4 families • http://www.channel4.com/programmes/nhs-2-billion-a-week-countingRos and Barrie

  24. What do we forfeit? For £100,000 you could also fund: 96 tonsillectomies 111 cataract operations 459 ambulance call outs 943 A+E visits 3125 GP appointments

  25. Summary • Why economics in healthcare? • Overview of different economic evaluation techniques • Examples from the literature • Examples to work through

  26. Useful references • McFarland, A. (2014). Economic evaluation of interventions in health care. Nursing Standard. 29 (10). p49-58. • Robison, R. (1993). Costs and cost-minimisation analysis. BMJ. 307 (6906). p726-8. • Robinson, R. (1993). Cost-effectiveness analysis. BMJ. 307 (6907). p793-5. • Robinson, R. (1993). Cost-utility analysis. BMJ. 307 (6908). p859-62. • Robinson, R. (1993). Cost-benefit analysis. BMJ. 307 (6909). p924-6. • More advanced texts: • Drummond, M. (2005). Common methodological flaws in economic evaluations. Medical Care. 43 (7) pII-5 – II-14. • Drummond, MF, Sculpher, MJ, Torrance, GW, O’Brien, BJ, Stoddart, GL. (2005). Methods for the Economic Evaluation of Health Care Programmes. Oxford, Oxford University Press.

  27. Quarterly newsletter Previous agreement among Community Advisors that a quarterly newsletter would be of interest We are keen to hear your views on the content and style of a quarterly newsletter • What types of updates would you be most interested in? - Interviews with researchers - Sharing experiences of being involved in SHAIPI research - Progress on SHAIPI research studies - Alerted to SHAIPI publications - Links to relevant news articles or published reports etc. • Do you have a preference for text / visuals / colours? • Formal or informal feel?

  28. Learn a little about recommended stages to develop and evaluate complex interventions to change human behaviours: The Medical Research Council (MRC) framework

  29. Who are the MRC and what do they do? An organisation that invests in research on behalf of the UK tax payer – a funding body Their mission is to: • Encourage and support research to improve human health • Produce skilled researchers • Advance and disseminate knowledge and technology to improve the quality of life and economic competitiveness of the UK • Promote dialogue with the public about medical research Work ranges from laboratory research, for example on genes and molecules, right through to research with people, such as clinical trials and population studies

  30. Complex behaviours require complex interventions Many clinical trials test the effectiveness of behavioural interventions (e.g. to improve hand hygiene compliance) Behavioural interventions are complex, especially compared to pharmaceutical trials of a “pill” • Number of components and how they interact • Number and difficulty of behaviours required by those delivering or receiving the intervention • Number of outcomes • Flexibility in the delivery / tailoring of the intervention

  31. The MRC framework for the development and evaluation of complex interventions Craig et al. (2008) Key elements of the developmentand evaluation process

  32. Stage 1: Intervention development 1.1 Identifying the evidence base • Before a substantial evaluation or implementation is undertaken, the intervention must be developed to the point where it can reasonably be expected to have a worthwhile effect • The first step is to identify what is already known about similar interventions • If there is no recent, high quality systematic review of the relevant evidence, one should be conducted

  33. Stage 1: Intervention development 1.2 Identifying or developing theory • The rationale for a complex behavioural intervention, the changes that are expected, and how change is to be achieved may not be clear at the outset • Develop a theoretical understanding of the likely process of behaviour change by drawing on existing evidence and theory, supplemented if necessary by new primary research

  34. Stage 1: Intervention development 1.3 Modelling process and outcomes • Modelling a complex intervention feasibility/piloting and a full scale evaluation can provide important information about the design of both the intervention and the evaluation • A good theoretical understanding is needed of how the intervention causes change, so that weak links in the causal chain can be identified and strengthened • Sometimes making a logic model is a key way to illustrate these dynamics

  35. Example logic model

  36. Stage 2: Feasibility and piloting This stage involves addressing the key uncertainties that have been identified during development 2.1 Testing procedures (and materials) • Can you collect data you need? Is the intervention acceptable? 2.2 Estimating recruitment and retention • Can you get the sample you need? 2.3 Determining sample size (power analysis) • How many participants do you need to detect an effect?

  37. Stage 3: Evaluation There are a range of study designs to test an intervention (one size doesn’t fit all) 3.1 Assess effectiveness in terms of outcomes • Consider which outcome you will use to measure whether the intervention has worked or not – primary/secondary? 3.2 Understand the change processes • Did the intervention work in line with the proposed causal pathways? 3.3 Assess cost effectiveness • Does the intervention represent value for money?

  38. Stage 4: Implementation 4.1 Dissemination • Is the intervention ready to be be scaled up and rolled out across settings? Is further work required for it to be improved? 4.2 Surveillance and monitoring • What systems need to be put in place to monitor outcomes? 4.3 Long-term follow-up • Is the intervention effective over the longer term? E.g. >12 months

  39. The MRC framework for the development and evaluation of complex interventions Craig et al. (2008) Key elements of the developmentand evaluation process

  40. Behavioural Insights Team Antimicrobial Resistance and Antimicrobial Stewardship

  41. Professor Paul Flowers

  42. Engaging the public with antimicrobial resistance (AMR) @Paulflowers1 Collaborative product of work by: Kay Currie, Lesley Price, Adele Dickson, Caroline King, Mairi Young, Lucy Gozdzielewska, Matt Smith, Fraser Smith, Jennifer MacDonald, Jo McParland, Lynn Williams, Darren Langdridge, Jeni Park, Kareena McAloney Jacqui Reilly, Monika Djerf-Pierre and Mark Davis Safeguarding Health through Infection Prevention research group .

  43. Structure Background to AMR One Health and AMR Media and AMR Review of interventions to engage the public with AMR

  44. Background to AMR ‘The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant. Here is a hypothetical illustration. Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why Mr. X whose negligent use of penicillin changed the nature of the microbe’ (Alexander Fleming, Nobel Lecture, 11 December, 1945)’

  45. Background to AMR: how bad is it? In 2011 World Health Organization’s Director General, Margaret Chan, described antimicrobial resistance (AMR) as “one of the three greatest threats to human health” In 2013, Dame Sally Davies, the United Kingdom’s Chief Medical Officer, was quoted to have said that antimicrobial resistance was a catastrophe equal to terrorism and climate change (McCarthy, 2013) In 2015, AMR was listed on the United Kingdom’s National Risk Register of Civil Emergencies (Cabinet Office, 2015) The World Bank has warned that, by 2050, drug-resistant infections could cause global economic damage on a par with the 2008 financial crisis.

  46. Background to AMR: how bad will it be? Potential economic cost by 2050 - US$100 trillion (Goossen et al., 2005; O’Neill, 2016) AMR predicted to be the main cause of death for 10 million people globally each year by the year 2050 Routine surgery, cancer care and everyday infections will be increasingly fraught with additional health risks Health care will return to the pre- antibiotic era

  47. AMR must be understood as both complex and systemic Drivers of AMR are distributed across multiple and multilayered stakeholders This is the context of todays talks The complex drivers of AMR: it’s everywhere

  48. Background to AMR: ‘One health’ One Health is an approach which focuses upon health by looking at different species and the environment It means we have to take an inclusive approach to AMR Human intervention accelerates microbial adaption to antibiotics Resistance mechanisms can pass between bacteria Resistant bacteria can pass between individuals (e.g., visitor to patient within a ward)

  49. Background to AMR: ‘One health’ Resistant bacteria can pass between species (e.g., pig to human, or human to cat through stroking) Antimicrobials, resistant mechanisms and drug resistant bacteria can pass to and from the environment (e.g., hospital effluent or muck spreading in fields) AMR is situated in the environment rather than in individual bodies There is free flowing movement of AMR across the Globe We need to understanding and intervene in relation to these One Health qualities

More Related