Why Do Health Economists Promote Technology Adoption Rather Than the Search for Efficiency? A Proposal for a Change in Our Approach to Economic Evaluation in Health Care.
At a time of intense pressure on health care budgets, the technology management challenge is for disinvestment in low-value technologies and reinvestment in higher value alternatives. The aim of this article is to explore ways in which health economists might begin to redress the observed imbalance between the evaluation of new and existing in-use technologies. The argument is not against evaluating new technologies but in favor of the "search for efficiency," where the ultimate objective is to identify reallocations that improve population health in the face of resource scarcity. We explore why in-use technologies may be of low value and consider how economic evaluation analysts might embrace a broader efficiency lens, first through "technology management" (a process of analysis and evidence-informed decision making throughout a technology's life cycle) and progressing through "pathway management" (the search for efficiency gains across entire clinical care pathways). A number of model-based examples are used to illustrate the approaches.
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK (GS, SB).|Health Services Research Unit, University of Aberdeen, Aberdeen, UK (GS).
Graham
G
Scotland
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK (GS, SB).|Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada (SB).|School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada (SB).
Stirling
S
Bryan
D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D003661:Decision Support Techniques; D004470:Economics, Medical / Q000458:organization & administration*; D017598:Efficiency, Organizational; D015276:Health Care Rationing / Q000458:organization & administration*; D006801:Humans; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical / Q000379:methods*
cost-effectiveness analysis; decision analysis; economic evaluation; health economics methods