Health Technology Assessments by the National Institute for Health and Clinical Excellence (eBook)

A Qualitative Study

Michael Schlander (Autor)

eBook Download: PDF

2007 | 2007
XXX, 245 Seiten
Springer New York (Verlag)
978-0-387-71996-2 (ISBN)

Infos

The National Institute for Health and Clinical Excellence (NICE) has been regarded as a role model for the implementation of cost-effectiveness analysis (CEA), and is being closely watched by health care policy makers across the globe. This book examines Britain's highly acclaimed approach to CEA and its international potential. It dissects the robustness of the agency's technology appraisal processes as NICE evaluates innovative methods for diagnosis and intervention. Coverage provides a step-by-step explanation of the NICE appraisal process and examines its successes and limitations.

Michael Schlander is founder and chairman of the independent Institute for Innovation & Valuation in Health Care (InnoValHC), a non-profit, non-partisan scientific organization dedicated to research related to the utilization, effectiveness, efficiency, and quality of health care, with particular emphasis on novel approaches of service provision. He teaches health economics and innovation management at the University of Duisburg-Essen (Faculty of Medicine, since 2005) and at the University of Applied Economic Sciences Ludwigshafen, Germany (since 2002). Prior to his university appointment, he spent fifteen years in senior positions with international pharmaceutical companies in Germany, Belgium, and the United States, and six years in experimental brain research and clinical neurology at German universities.

---

First in a new series on economic issues in the context of health care policy, Health Technology Assessments by the National Institute for Health and Clinical Excellence examines Britain's highly acclaimed approach to cost-effectiveness analysis (CEA), and its international potential.The National Institute for Health and Clinical Excellence (NICE) has been regarded as a role model for the implementation of CEA, and is being closely watched by health care policy makers throughout Europe, and in the United States. This volume dissects the robustness of the agency's technology appraisal processes as NICE evaluates innovative methods for diagnosis and intervention. Given the unique features of attention-deficit/hyperactivity disorder (ADHD)-starting with it being diagnosed mainly in children and adolescents, its high comorbidity with other psychiatric conditions, and its considerable economic impact-the disorder is a perfect focal point for discussion.

Inhalt

Foreword I 6
Foreword II 8
Preface 9
Acknowledgments 11
1 Introduction 27
National Institute for Health and Clinical Excellence (NICE) 27
Attention-Deficit/Hyperactivity Disorder (ADHD) 32
2 A Note on Objectives and Methods 45
Objectives 45
Accountability for Reasonableness 45
Methods 47
Limitations 48
3 NICE Appraisal Process 50
Scoping 50
Assessment 52
Appraisal 56
Appeal 56
Clinical Guidelines 57
4 NICE Appraisal of ADHD Treatments 59
Scope 59
Assessment 60
Appraisal 61
Appeal 63
Clinical Guidelines 64
5 NICE Appraisal of ADHD Treatment Options: A Critique 67
Scoping 69
Data Selection for Assessment 71
Outcome Measures 74
Quality of Life and Utility Estimates 77
Selection of Clinical Effectiveness Studies for Economic Evaluation 81
Efficacy, Effectiveness, and Treatment Compliance 90
Internal Versus External Validity of Clinical Trials 91
Quantitative Evidence on Treatment Compliance 94
Treatment Compliance of Patients with ADHD 95
Data Synthesis Across Endpoints and Studies 100
Data Synthesis Across Endpoints 111
Data Synthesis Across Clinical Studies 113
Economic Model 116
Literature Review 117
Structure of the Model 118
Economic Model Results 125
Appraisal and Appeal Process 130
6 Discussion and Implications 136
The Case Study 136
Insights from Clinical Long-Term Studies 140
Insights from Disease-Specific Effectiveness Measures 148
Case Analysis: Symptoms and Underlying Problems 163
Separation of Clinical and Economic Perspectives 165
High Level of Standardization 166
Technical Quality of Assessment 169
Process-Related Issues 170
NICE Accountability for Reasonableness 171
Publicity 171
Relevance 174
Appeal 176
Enforcement 177
NICE Technology Appraisal No. 98 -- A Unique Outlier? 178
Implications for International Health Care Policy-Makers 180
Objectives of Health Care Provision 180
(Almost) Exclusive Reliance on QALYs as Outcome Measure? 182
Technology Appraisal Processes 182
Timing of Technology Appraisals 184
Multidisciplinary Assessment Teams 184
Quality Assurance 185
Implementation 185
7 Which Way Forward? 189
Starting Points 189
Affordability 191
Institutional Context 193
Objectives, Reconsidered 195
Efficiency 195
Fairness 198
Research Agenda 200
Final Note 202
Appendix AAbbreviations and Use of Terminology 204
Appendix BCritical Gaps of Assessment 208
Appendix CConsistency Issues Associated with NICE Assessment 212
References 220
About the Author 252
About the Author 1
Index 253

Produkt-Details

• Erscheint lt. Verlag: 30.11.2007
• Reihe/Serie: Innovation and Valuation in Health Care
• Reihe/Serie: Innovation and Valuation in Health Care
• Zusatzinfo: XXX, 245 p.
• Verlagsort: New York
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Pflege
• Themenwelt: Studium ► Querschnittsbereiche ► Prävention / Gesundheitsförderung
• Themenwelt: Technik ► Medizintechnik
• Schlagworte: Assessment • cost effectiveness analysis • Diagnosis • Evidence-based Medicine • Health Economics • health policy • health services research • Health Technology Assessment • HTA • outcomes assessment
• ISBN-10: 0-387-71996-2 / 0387719962
• ISBN-13: 978-0-387-71996-2 / 9780387719962