SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs

Health Research Policy and Systems, Dec 2009

This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. We suggest four questions that can be considered when assessing resource use and the cost consequences of an option. These are: 1. What are the most important impacts on resource use? 2. What evidence is there for important impacts on resource use? 3. How confident is it possible to be in the evidence for impacts on resource use? 4. Have the impacts on resource use been valued appropriately in terms of their true costs?

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SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs

Health Research Policy and Systems Guide SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs Andrew D Oxman 2 Atle Fretheim 1 John N Lavis 0 Simon Lewin 3 0 Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, and Department of Political Science, McMaster University , 1200 Main St. West, HSC-2D3, Hamilton, ON , Canada , L8N 3Z5 1 Norwegian Knowledge Centre for the Health Services , P.O. Box 7004, St. Olavs plass, N-0130 Oslo , Norway; Section for International Health, Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo , Norway 2 Norwegian Knowledge Centre for the Health Services , P.O. Box 7004, St. Olavs plass, N-0130 Oslo , Norway 3 Norwegian Knowledge Centre for the Health Services , P.O. Box 7004, St. Olavs plass, N-0130 Oslo , Norway; Health Systems Research Unit, Medical Research Council of South Africa This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address considerations about resource use and costs. The consequences of a policy or programme option for resource use differ from other impacts (both in terms of benefits and harms) in several ways. However, considerations of the consequences of options for resource use are similar to considerations related to other impacts in that policymakers and their staff need to identify important impacts on resource use, acquire and appraise the best available evidence regarding those impacts, and ensure that appropriate monetary values have been applied. We suggest four questions that can be considered when assessing resource use and the cost consequences of an option. These are: 1. What are the most important impacts on resource use? 2. What evidence is there for important impacts on resource use? 3. How confident is it possible to be in the evidence for impacts on resource use? 4. Have the impacts on resource use been valued appropriately in terms of their true costs? - About STP This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. The series is intended to help such people ensure that their decisions are well-informed by the best available research evidence. The SUPPORT tools and the ways in which they can be used are described in more detail in the Introduction to this series [1]. A glossary for the entire series is attached to each article (see Additional File 1). Links to Spanish, Portuguese, French and Chinese translations of this series can be found on the SUPPORT website http:// www.support-collaboration.org. Feedback about how to improve the tools in this series is welcome and should be sent to: . Scenario You work in the Ministry of Health and the Minister of Health has asked you to brief her on the costs of options being considered as part of a healthcare reform programme. Background In this article, we present four questions that policymakers and those who support them can ask when assessing the costs of a policy or programme option. Such questions could be applied, for instance, in the scenario outlined above. Our focus is on finding and using evidence related to resource use and the costs of a policy or programme option, rather than on cost-effectiveness analysis or other types of economic analysis. Policymakers want to ensure that policies represent good value for money, as do those affected by them. To do this it is essential to consider the costs of options as well as their health and other impacts. Option costs differ from other impacts in a number of key ways [2]: Healthcare costs are typically shared. For most impacts other than costs, it is usually clear who will be advantaged and who will be disadvantaged, though this may not be the case for all outcomes. An entire community will benefit from a vaccination programme because of the herd effect (the reduced transmission of the disease once most community members are vaccinated). Similarly, in the case of the widespread use of antibiotics to treat individual infections, downstream adverse consequences of drug resistance may occur for the wider community. These are exceptions for health outcomes. On the other hand, healthcare costs are typically shared by the government, private insurers, employers and patients. And within a society, how costs are shared may differ still further depending on patient age (e.g. whether they are under or over 65) or circumstance (e.g. whether the patient is receiving social assistance). Unit costs tend to vary widely across jurisdictions. For instance, the cost per unit of drugs is largely unrelated to the actual costs of production but is instead more closely related to marketing decisions and national policies. Thus, for e (...truncated)


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Andrew D Oxman, Atle Fretheim, John N Lavis, Simon Lewin. SUPPORT Tools for evidence-informed health Policymaking (STP) 12: Finding and using research evidence about resource use and costs, Health Research Policy and Systems, 2009, pp. S12, 7, DOI: 10.1186/1478-4505-7-S1-S12