Cost-effectiveness analysis and formulary decision making in England: Findings from research

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Cost-effectiveness analysis and formulary decision making in England: Findings from research. / Williams, Iestyn; Bryan, Stirling.

In: Social Science & Medicine, Vol. 65, No. 10, 01.11.2007, p. 2116-2129.

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@article{e1fbf07867e7420b972e9de6480c0e21,
title = "Cost-effectiveness analysis and formulary decision making in England: Findings from research",
abstract = "In a context of rapid technological advances in health care and increasing demand for expensive treatments, local formulary committees are key players in the management of scarce resources. However, little is known about the information and processes used when making decisions on the inclusion of new treatments. This paper reports research on the use of economic evaluations in technology coverage decisions in England, although the findings have a relevance to other health care systems with devolved responsibility for resource allocation. It reports a study of four local formulary committees in which both qualitative and quantitative data were collected. Our main research finding is that it is an exception for cost-effectiveness analysis to inform technology coverage decisions. Barriers to use include access and expertise levels, concerns relating to the independence of analyses and problems with implementation of study recommendations. Further barriers derive from the constraints on decision makers, a lack of clarity over functions and aims of local committees, and the challenge of disinvestment in medical technologies. The relative weakness of the research-practice dynamics in this context suggests the need for a rethinking of the role of both analysts and decision makers. Our research supports the view that in order to be useful, analysis needs to better reflect the constraints of the local decision-making environment. We also recommend that local decision-making committees and bodies in the National Health Service more clearly identify the 'problems' which they are charged with solving and how their outputs contribute to broader finance and commissioning functions. This would help to establish the ways in which the routine use of cost-effectiveness analysis might become a reality.",
keywords = "cost effectiveness, technology coverage, economic evaluation, formulary decision making, England, UK, health policy, National health service (NHS)",
author = "Iestyn Williams and Stirling Bryan",
year = "2007",
month = nov,
day = "1",
doi = "10.1016/j.socscimed.2007.06.009",
language = "English",
volume = "65",
pages = "2116--2129",
journal = "Social Science and Medicine",
issn = "0277-9536",
publisher = "Reed-Elsevier (India) Private Limited",
number = "10",

}

RIS

TY - JOUR

T1 - Cost-effectiveness analysis and formulary decision making in England: Findings from research

AU - Williams, Iestyn

AU - Bryan, Stirling

PY - 2007/11/1

Y1 - 2007/11/1

N2 - In a context of rapid technological advances in health care and increasing demand for expensive treatments, local formulary committees are key players in the management of scarce resources. However, little is known about the information and processes used when making decisions on the inclusion of new treatments. This paper reports research on the use of economic evaluations in technology coverage decisions in England, although the findings have a relevance to other health care systems with devolved responsibility for resource allocation. It reports a study of four local formulary committees in which both qualitative and quantitative data were collected. Our main research finding is that it is an exception for cost-effectiveness analysis to inform technology coverage decisions. Barriers to use include access and expertise levels, concerns relating to the independence of analyses and problems with implementation of study recommendations. Further barriers derive from the constraints on decision makers, a lack of clarity over functions and aims of local committees, and the challenge of disinvestment in medical technologies. The relative weakness of the research-practice dynamics in this context suggests the need for a rethinking of the role of both analysts and decision makers. Our research supports the view that in order to be useful, analysis needs to better reflect the constraints of the local decision-making environment. We also recommend that local decision-making committees and bodies in the National Health Service more clearly identify the 'problems' which they are charged with solving and how their outputs contribute to broader finance and commissioning functions. This would help to establish the ways in which the routine use of cost-effectiveness analysis might become a reality.

AB - In a context of rapid technological advances in health care and increasing demand for expensive treatments, local formulary committees are key players in the management of scarce resources. However, little is known about the information and processes used when making decisions on the inclusion of new treatments. This paper reports research on the use of economic evaluations in technology coverage decisions in England, although the findings have a relevance to other health care systems with devolved responsibility for resource allocation. It reports a study of four local formulary committees in which both qualitative and quantitative data were collected. Our main research finding is that it is an exception for cost-effectiveness analysis to inform technology coverage decisions. Barriers to use include access and expertise levels, concerns relating to the independence of analyses and problems with implementation of study recommendations. Further barriers derive from the constraints on decision makers, a lack of clarity over functions and aims of local committees, and the challenge of disinvestment in medical technologies. The relative weakness of the research-practice dynamics in this context suggests the need for a rethinking of the role of both analysts and decision makers. Our research supports the view that in order to be useful, analysis needs to better reflect the constraints of the local decision-making environment. We also recommend that local decision-making committees and bodies in the National Health Service more clearly identify the 'problems' which they are charged with solving and how their outputs contribute to broader finance and commissioning functions. This would help to establish the ways in which the routine use of cost-effectiveness analysis might become a reality.

KW - cost effectiveness

KW - technology coverage

KW - economic evaluation

KW - formulary decision making

KW - England

KW - UK

KW - health policy

KW - National health service (NHS)

U2 - 10.1016/j.socscimed.2007.06.009

DO - 10.1016/j.socscimed.2007.06.009

M3 - Article

C2 - 17698271

VL - 65

SP - 2116

EP - 2129

JO - Social Science and Medicine

JF - Social Science and Medicine

SN - 0277-9536

IS - 10

ER -