Authors: Karnon, Jonathan; Carlton, Jill; Czoski-Murray, Carolyn; Smith, Kevin

Source: Applied Health Economics and Health Policy, Volume 7, Number 1, 1 March 2009 , pp. 1-9(9)

Publisher: Adis International

Abstract:

The mandatory nature of recommendations made by the National Institute for Health and Clinical Excellence (NICE) in the UK has highlighted inherent difficulties in the process of disinvestment in existing technologies to fund NICE-approved technologies. A lack of evidence on candidate technologies means that the process of disinvestment is subject to greater uncertainty than the investment process, and inefficiencies may occur as a result of the inverse evidence law.

This article describes a potential disinvestment scenario and the options for the decision maker, including the conduct of value of information analyses. To illustrate the scenario, an economic evaluation of a disinvestment candidate (screening for amblyopia and strabismus) is presented. Only very limited data were available. The reference case analysis found that screening is not cost effective at currently accepted values of a QALY. However, a small utility decrement due to unilateral vision loss reduced the incremental cost per QALY gained, with screening expected to be extremely cost effective.

The discussion highlights the specific options to be considered by decision makers in light of the model-based evaluation. It is shown that the evaluation provides useful information to guide the disinvestment decision, providing a range of focused options with respect to the decision and the decision-making process.

A combination of explicit model-based evaluation, and pragmatic and generalizable approaches to interpreting uncertainty in the decision-making process is proposed, which should enable informed decisions around the disinvestment of technologies with weak evidence bases.

Document Type: Research article

Affiliations: 1: University of Sheffield, Sheffield, UK

Publication date: 2009-03-01

More about this publication?

• Information for Authors
• ingentaconnect is not responsible for the content or availability of external websites

Related content

• In this: publication
• By this: publisher
• In this Subject: Economics ,  Medicine (General)
• By this author: Karnon, Jonathan ;  Carlton, Jill ;  Czoski-Murray, Carolyn ;  Smith, Kevin

Website © Publishing Technology. Article copyright remains with the publisher, society or author(s) as specified within the article.

• Terms and conditions
• Privacy policy
• Information for advertisers