Speakers
Dr. Gwyn Bevan is a Professor of Policy Analysis and Head of the Department of Management at the London School of Economics and Political Science. His current research includes comparisons of performance of health care and schools across the countries of the UK and developing methods for reducing expenditure on health care for least harm. He is a member of the Department of Health’s two advisory groups on resource allocation. He has worked for the National Coal Board, HM Treasury, an economic consultancy and the Commission for Health Improvement; and, as an academic, at Warwick Business School, and the Medical Schools of St. Thomas’s Hospital and Bristol University.
Resources
Webcast: http://webcast.otn.ca/index/browse?page=1&type=3
Two different paradigms have been developed for the purpose of setting priorities in health care: needs assessment from epidemiology, and Cost-Effectiveness Analysis (CEA) from health economics. Needs assessment and CEA both use methods of weighting states of health. Disability-Adjusted Life Years (DALYs) estimate the needs of populations in terms of the current Burden of Disease (BoD) and tend to be used in developing countries (following the work of Christopher Murray). CEA estimates gains in health in Quality-Adjusted Life Years (QALYs) and frames priorities in terms of Incremental Cost-Effectiveness Ratios (ICERs) in the form of Cost/QALY and is the dominant paradigm in framing priorities in the UK and the USA. As CEA focuses on marginal changes,this approach does not consider the scale of change, which is vital in setting strategic priorities. DALYs do give information on scale in terms of the BoD, but estimates of the current BoD in developed countries does not offers a sound a basis for setting priorities: simplistic use of such estimates might lead to resources being directed at diseases with a large current BoD, but for which there is no effective remedy. Hence the need to identify the ‘avoidable’ BoD: i.e. that which can be reduced by health care. We discovered a flaw in the way that the conventional method of estimating DALYs, based on life tables, can produce odd estimates of the impact of interventions in terms of population health gains. The Systems Modelling for Performance Optimisation and Service Equity (SyMPOSE) research programme at LSE has sought to combine the two paradigms by developing a method of applying CEA to populations: the Socio-Technical Allocation of Resources. STAR estimates costs of services and their impact at the level of populations. This requires identifying health gains at the population level or their ‘avoidable’ BoD (and hence may be described as either reductions in the BoD or gains in health). STAR uses visual models to display these estimates, which enables stakeholders (including patients, clinicians, managers of providers and commissioners) to estimate the impacts of interventions on the health of populations, relate these to their costs, see their relative Value for Money (VfM), understand hard choices and set priorities. This talk describes how the STAR approach was developed by drawing on concepts of ‘avoidable deaths’, CEA and DALYs.