#HEJC for 04/03/2013

This month’s meeting will take place Monday 4th March, at 8pm London time. That’ll be 9pm in Rome and 1:30am on Tuesday in Mumbai. Join the Facebook event here. For more information about the Health Economics Twitter Journal Club and how to take part, click here.

The paper for discussion this month is published in Health Economics and the authors are Katherine Payne, Marion McAllister and Linda Davies. The title of the paper is:

“Valuing the economic benefits of complex interventions: when maximising health is not sufficient”

Following the meeting, a transcript of the discussion can be downloaded here.

Links to the article

Official: http://onlinelibrary.wiley.com/doi/10.1002/hec.2795/abstract

RePEc: http://ideas.repec.org/a/wly/hlthec/v22y2013i3p258-271.html

Other: tbc

Summary of the paper

This paper argues that complex healthcare interventions represent a challenge to the application of current methods of economic evaluation. The authors argue that, in some cases, it may not be sufficient to focus only on measuring and maximising health gain. The complexity of an intervention may mean that it does not fit into one of the current standard appraisal systems for health technology assessment or public health services. Maximising health is often not the only objective of a complex intervention and as such there is a need to identify methods for evaluation beyond health gain. This paper discusses the implications of a programme of work that focused on clinical genetics services, as an example of a complex intervention. The authors seek to identify the attributes that comprise both health and non-health aspects of benefits and whether it is possible to evaluate such an intervention using current NICE appraisal processes. Genetic services and tests have broader objectives than just health gain. The study identifies ’empowerment’ as a primary domain for benefit measurement in this case; an outcome closely related to the concept of ‘capabilities’. The authors conclude that further methodological work is required to identify the trade-off between non-health (empowerment) and health benefits for other complex interventions, and suggest a more considered approach to the valuation of non-health benefits.

Discussion points

  • Should ‘complex’ interventions be treated any differently?
  • Which other complex interventions require more thorough consideration in this regard?
  • Can/should a healthcare intervention with no health benefits ever be considered cost-effective?
  • Can/should ’empowerment’ be valued from a societal perspective?

Missed the meeting? Add your thoughts on the paper in the comments below.

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