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?
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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)