Evidence-Based Treatment
Barbara A. Wilson, Jill Winegardner, Caroline M. van Heugten, Tamara Ownsworth in Neuropsychological Rehabilitation, 2017
Economic evaluation can be defined as the comparative analysis of alternative courses of action in terms of costs on the one hand (resource use) and consequences on the other hand (outcomes, effects) (Adamiak, 2006). The aim of economic evaluation studies is to describe, measure and value all relevant alternative costs and consequences (e.g. intervention X versus comparator Y) (Shemilt et al., 2011). Different types of economic evaluation exist, such as cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. In partial economic evaluations (e.g. cost-analyses and cost-description studies), less evidence on the description, measurement or valuation of health-care interventions and technologies is provided in comparison to full economic evaluations. To give a relevant example of the difference between partial and full economic evaluations, we recently published a full economic evaluation of an augmented cognitive behavioural therapy intervention in comparison to computerised cognitive training for post-stroke depressive symptoms (Van Eeden et al., 2015). In this study both costs and effects were taken into account from a societal perspective. A few years ago we published a cost-analysis of a residential community reintegration programme for severe brain injury patients where only the costs of the programme but not the effects were taken into account (van Heugten et al., 2011).
The economics of chronic pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Cost–benefit analysis enables the notion of efficiency to be viewed from a higher level, that of allocative efficiency, in that it enables judgments to be made about the relative value of pursuing one objective (e.g. full restoration of a person to employment) as opposed to another (e.g. ability to pursue some aspects of normal functioning). Cost–effectiveness analysis, on the other hand, can only provide an indication of technical efficiency, since it provides an assessment of different ways of fulfilling the same objective (for example, securing pain relief). However, cost–benefit analysis is reliant on being able to place monetary values on the identified costs and benefits. This is possible where, for example, people are willing to pay for a reduction in pain. Methods of arriving at indicators of willingness-to-pay can be arrived at by asking people directly through, for example, questionnaires. One such method is the contingent valuation approach, which asks people the maximum amount they would be prepared to pay for the benefit. An alternative to the questionnaire approach is to employ proxy values; for example, the price people would be prepared to pay for surgery in a private hospital would be an indicator of how much they were willing to pay to avoid having to join a waiting list. However, there are many issues relating to the translation of health outcomes into a monetary measure and thus cost–benefit analysis is not widely used when undertaking health economic evaluations.
Epistemic paternalism
Kalle Grill, Jason Hanna in The Routledge Handbook of the Philosophy of Paternalism, 2018
What about reasons that are neither epistemic nor moral? Say, in particular, that we perform a financial cost-benefit analysis, and it turns out that the costs outweigh the benefits. Does that provide a reason against interference? It is not clear that it does in the kinds of situations that concern us in the present case for epistemic paternalism. The reason is that we have moral reasons for interference, as we saw above, and that moral reasons silence countervailing, non-moral reasons.3 For present purposes, such silencing doesn’t require authoritative moral reasons, operating independently of desires or interests. After all, insofar as we are inclined to interfere with the inquiry of another in the kind of context that has concerned us, our motivations are most plausibly understood as grounded in a moral concern, such as a moral concern for the welfare of the defendant or for doing right by those wronged, which silences reasons owing to non-moral considerations. That much should be largely uncontroversial. Those critical of “Humean” silencing (e.g., Joyce 2006) are not concerned that moral reasons grounded in present desires cannot silence non-moral reasons – they are concerned that this is the only kind of silencing there is, on a Humean picture. But that complaint need not concern us here. That means that, if we can show that the epistemic reasons involved are aligned with our moral reasons on the issue, then no further kinds of reasons need to be considered for us to conclude that the alignment condition is satisfied. Consequently, the aforementioned type of evidence control can be taken to satisfy that condition.
Using cost-analyses to inform health professions education – The economic cost of pre-clinical failure
Published in Medical Teacher, 2018
Jonathan Foo, Dragan Ilic, George Rivers, Darrell J. R. Evans, Kieran Walsh, Terry P. Haines, Sophie Paynter, Prue Morgan, Stephen Maloney
The process of calculating costs, without a measure of effect, is known as cost-analysis. This is not to be confused with a calculation of costs and effects, which include cost-effectiveness, cost–benefit, and cost–utility analyses. Cost-analyses can generally be conducted from a top-down or bottom-up approach. The top-down approach is based on an overall total cost which is then divided by total units. Top-down costing typically relies on established databases and assumptions around large group averages, and is thus prone to generalizations (Mogyorosy and Smith 2005). Applying a top-down approach, Dobson and Sharma (1999) calculated the cost of failure in Australian bachelor level higher education at AU$360 million annually. Dobson and Sharma based their calculations on monetary costs arising from payments made by students as well as government funding.
Twelve tips for assessing medical knowledge with open-ended questions: Designing constructed response examinations in medical education
Published in Medical Teacher, 2020
Karen E. Hauer, Christy Boscardin, Judith M. Brenner, Sandrijn M. van Schaik, Klara K. Papp
Resources required to implement summative constructed response assessments include time for faculty to write questions and score student responses, assessment technology for obtaining student responses and storing performance data electronically and securely, and time and expertise for faculty and staff training. Any structural and policy changes to the student assessment system should balance costs with goals of the assessment (Norcini et al. 2018). Sustainability of an assessment method depends upon cost effectiveness and feasibility. Costs are weighed against the perceived value of the assessment data generated. Based on our experience, faculty perceive they gain valuable insights into students’ learning through constructed response examinations, a benefit that offsets the time spent reviewing and scoring student responses. For comprehensive cost-analysis, estimating both required resources and program outcomes and benefits is useful. Determining feasibility for adoption and implementation will depend on amount of resources allocated, buy-in and cultural shift around assessment from all key stakeholders. Important elements to consider prior to adoption should include a) acceptability to stakeholders, b) practicality – resources, and time commitment, c) integration – the level of alignment or disruption to the current curriculum, and d) pilot testing – rather than full implementation, small scale pilots may be conducted in a convenience sample with shorter follow-up periods for improvements and adaptation.
Assessing adherence and cost-benefit of colorectal cancer screening for accountable providers
Published in Baylor University Medical Center Proceedings, 2019
Trace Heavener, Frank W. McStay, Victoria Jaeger, Kristen Stephenson, Lauren Sager, James Sing
Financial calculations were carried out in a separate Excel file. Medicare’s 2017 physician, clinical diagnostic library, and anesthesia fee schedules were used with national payment instead of geographic-specific amounts (Table 1). The most frequent complications and rates associated with colonoscopy were estimated with diagnosis-related group codes using the Texas PricePoint tool (Table 1).37,38 Authors identified six CRC treatment cost studies, inflated the average reported in the studies to 2017 dollars using the Consumer Price Index, and calculated the mean cost.38,39 The cost of distant (stages 3 and 4) CRC ($42,039.70) treatment was adjusted downward, as demonstrated by Zhehui et al, to obtain the cost of local (stages 1 and 2) CRC treatment by 0.9204.40 In constructing the CBM, multiple assumptions were made and are listed under corresponding tables. Further, dysplastic polyps were categorized as local CRC, adenomatous polyps were estimated to have a 25% annualized risk of progression to CRC, and hyperplastic polyps were estimated to have a negligible risk of progression to CRC.41–47 Findings from the quality improvement/statistical analysis were used to inform the cost-benefit analysis.
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