Article type
Year
Abstract
Background: Cochrane reviews are a valuable resource for decision-makers but many reviews do not provide definitive information due to the paucity of data available. Treatment and policy decisions, however, still have to be made. To aid these, the information provided by a review can be used to explore the implications of alternative decisions. For example, choosing an intervention that is twice as costly as a comparator when health care budgets are fixed implies that it is considered to be at least twice as effective. The aim of this presentation is to explore the implied value approach to decision-making using the results from a series of reviews of the management of incontinence.
Methods: Each review provided limited data on effectiveness but sufficient data to allow costs to be estimated. Differences in cost were used to assess the implied values of alternative decisions. The reviews were used to assist judgements about whether this valuation was plausible in practice.
Results: As an example of the approach, in a review of containment products the estimated costs per patient per year were 2,141 and 2,100 for disposable and reusable bodyworns respectively. Choosing disposable bodyworns implies that they provided at least 2% more benefit and that society would be willing to pay the additional 41 per patient per year. The limited data from the review indicated that disposables were associated with fewer skin complaints and were preferred by patients. However, there was no information on the likely costs of disposing of products. A 2% benefit is not improbable in this case; therefore, a judgement is required about whether society would be willing to pay the additional costs of provision and disposal of products.
Conclusion: Incontinence is estimated to affect some 3 million people and be responsible for 2% of the health care budget in the UK yet only sparse data are available about how best it can managed. The implied value approach can allow the results of even inconclusive reviews to be of use in practice. It does this by providing a framework that allows the judgements to be made in a manner that is makes the most of limited effectiveness data
Methods: Each review provided limited data on effectiveness but sufficient data to allow costs to be estimated. Differences in cost were used to assess the implied values of alternative decisions. The reviews were used to assist judgements about whether this valuation was plausible in practice.
Results: As an example of the approach, in a review of containment products the estimated costs per patient per year were 2,141 and 2,100 for disposable and reusable bodyworns respectively. Choosing disposable bodyworns implies that they provided at least 2% more benefit and that society would be willing to pay the additional 41 per patient per year. The limited data from the review indicated that disposables were associated with fewer skin complaints and were preferred by patients. However, there was no information on the likely costs of disposing of products. A 2% benefit is not improbable in this case; therefore, a judgement is required about whether society would be willing to pay the additional costs of provision and disposal of products.
Conclusion: Incontinence is estimated to affect some 3 million people and be responsible for 2% of the health care budget in the UK yet only sparse data are available about how best it can managed. The implied value approach can allow the results of even inconclusive reviews to be of use in practice. It does this by providing a framework that allows the judgements to be made in a manner that is makes the most of limited effectiveness data