Skip to main content
×
Home

REFLECTIONS ON THE NICE DECISION TO REJECT PATIENT PRODUCTION LOSSES

  • James Shearer (a1), Sarah Byford (a2) and Steve Birch (a3)
Abstract

Objectives: Patient production losses occur when individuals’ capacities to work, whether paid or unpaid, are impaired by illness, treatment, disability, or death. There is controversy about whether and how to include patient production losses in economic evaluations in health care. Patient production losses have not previously been considered when evaluating medications for reimbursement under the U.K. National Health Service. Proposals for value-based assessment of health technologies in the United Kingdom created renewed interest in whether and how to include costs from a wider societal perspective, such as patient production losses, within economic evaluation of healthcare interventions.

Methods: A narrative review was undertaken of theoretical, ethical, and policy issues that might inform decisions that involve the normative question of whether or not to include patient production losses in economic evaluation.

Results: It seems difficult to reconcile the implications of including patient production losses with the objectives of a healthcare system dedicated to providing universal healthcare coverage without regard to patients’ ability to pay.

Conclusions: Tax payer funded healthcare systems may legitimately adopt maximands other than health gain, but these will be at the opportunity cost of less than maximum health gains.

Copyright
References
Hide All
1. NICE. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence; 2013.
2. Garau M, Shah K, Sharm P, Towse A. Is the link between health and wealth considered in decisionmaking? Results from a qualitative study. Int J Technol Assess Health Care. 2016;31:18.
3. Krol M, Papenburg J, Koopmmanschap M, Brouwer W. Do productivity costs matter? The impact of inlcuding productivity costs on the incremental costs of interventions targetted at depressive disorders. PharmacoEconomics. 2011;29:601619.
4. Brouwer W, Rutten F, Koopmanschap M. Costing in economic evaluations. In: Drummond C, McGuire A, eds. Economic evaluation in health care: Merging theory with practice. Oxford: Oxford University Press; 2001:6893.
5. Drummond M, Sculpher M, Torrance G, O'Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 2005.
6. Sculpher M. The role and estimation of productivity costs in economic evaluation In: Drummond M, McGuire A, eds. Economic evaluation in health care: merging theory with practice. Oxford: Oxford University Press; 2001:94112.
7. Olsen J, Richardson J. Production gains from health care: What should be included in cost-effectiveness analysis. Soc Sci Med. 1999;49:1726.
8. Luce B, Manning W, Siegel J, Lipscomb J. Estimating costs in cost-effectiveness analysis. In: Gold M, Siegel J, Russell L, Weinstein M, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996:176213.
9. Lensberg B, Drummond M, Danchenko N, Despiegel N, Francois C. Challenges in measuring and valuing productivity costs, and their relevance in mood disorders. Clinicoecon Outcomes Res. 2013;5:565573.
10. Zhang W, Bansback N, Anis A. Measuring and valuing productivity loss due to poor health: A critical review. Soc Sci Med. 2011;72:185192.
11. Herrero C, Moreno-Ternero J. Estimating production costs in the economic evaluation of health-care programs. Health Econ. 2009;18:2135.
12. Brouwer W, Koopmanscahp M, Rutten F. Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel. Health Econ. 1997;6:253259.
13. Koopmanschap M, Rutten FFH, Vanineveld B, Vanroijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14:171189.
14. Kigozi J, Jowett S, Lewis M, Barton P, Coast J. Estimating productivity costs using the friction cost approach in practice: a systematic review. Eur J Health Econ. 2016;17:3144.
15. Morris S, Devlin N, Parkin D, Spencer A. Economic analysis in health care. 2nd ed. Chichester: Wiley; 2012.
16. Williams A. Cochrane lecture. All cost effective treatments should be free. . . or, how Archie Cochrane changed my life! J Epidemiol Community Health. 1997;51:116120.
17. Richardson J. Economic assessment of health care: Theory and practice. Aust Econ Rev. 1991;24:421.
18.Office for National Statistics. Annual survey of hours and earnings: 2016 provisional results. 2016. https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/earningsandworkinghours/bulletins/annualsurveyofhoursandearnings/2016provisionalresults (accessed February 25, 2017).
19. Claxton K, Sculpher M, Palmer S, Culyer A. Causes for concern: Is NICE failing to uphold its responsibilities to all NHS patients? Health Econ. 2015;24:17.
20. Claxton K, Walker S, Palmer S, Sculpher M. Appropriate perspectives for health care decisions. York: Centre for Health Economics, 2010; Paper 54.
21. Mason H, Jones-Lee M, Donaldson C. Modelling the monetary value of a QALY: A new approach based on UK data. Health Econ. 2009;18:933950.
22. McKie J, Richardson J. The rule of rescue. Soc Sci Med. 2003;56:24072419.
23. Arrow K. Uncertainty and the welfare economics of medical care. Am Econ Rev. 1963;53:941973.
24. Brouwer W, Culyer A, van Exel N, Rutten F. Welfarism vs. extra-welfarism. J Health Econ. 2008;27:325338.
25. Gerard K, Mooney G. QALY league tables: Handle with care. Health Econ. 1993;2:5964.
26. Gold M, Siegel J, Russell L, Weinstein M. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
27. Klein R. The new politics of the NHS. 7th ed. London: Radcliffe Publishing; 2013.
28. Department of Health. The NHS Constitution for England. London: Department of Health; 2013.
29. Gottret P, Schieber G. Health financing revisited: A practitioner's guide. Washington DC: The World Bank; 2006.
30. Donaldson C, Gerard K. Economic of health care financing: The visible hand. 2nd ed. Basingstoke: Palgrave Macmillan; 2005.
31. Layte R, Nolan A. Income-related inequity in the use of GP services by children: A comparison of Ireland and Scotland. Eur J Health Econ. 2015;16:489506.
32. Paulden M. Recent amendments to NICE's value-based assessment of health technologies: Implicitly inequitable? Expert Rev Pharmacoecon Outcomes Res. 2017;17:239242.
33. Walker S, Griffin S, Claxton K, Palmer S, Sculpher M. Appropriate perspectives for health care decisions. In: Curtis L, ed. Unit costs of health and social care 2012. Canterbury: Personal Social Services Research Unit; 2012:811.
34. Linley W, Hughes D. Societal views on NICE, cancer drugs fund and value based fundig criteria for prioritising medicines: A cross-sectional survey of 4118 adults in Great Britain. Health Econ. 2013;22:948964.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 36 *
Loading metrics...

Abstract views

Total abstract views: 201 *
Loading metrics...

* Views captured on Cambridge Core between 20th November 2017 - 11th December 2017. This data will be updated every 24 hours.