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Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services

David Cohen, M Alam, Nishma Patel, Wai-Yee Cheung, John G Williams, Ian T Russell, Fasihul Alam

Cost Effectiveness and Resource Allocation, Volume: 12, Issue: 1, Start page: 7

Swansea University Author: Fasihul Alam

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DOI (Published version): 10.1186/1478-7547-12-7

Abstract

BACKGROUND: Complex clinical interventions are increasingly subject to evaluation by randomised trial linked to economic evaluation. However evaluations of policy initiatives tend to eschew experimental designs in favour of interpretative perspectives which rarely allow the economic evaluation metho...

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Published in: Cost Effectiveness and Resource Allocation
Published: 2014
URI: https://cronfa.swan.ac.uk/Record/cronfa20827
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first_indexed 2015-04-22T02:08:22Z
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spelling 2015-04-21T17:23:58.2404741 v2 20827 2015-04-21 Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services 642c9290a11352cb60741fc2b1004f6d Fasihul Alam Fasihul Alam true false 2015-04-21 HHE BACKGROUND: Complex clinical interventions are increasingly subject to evaluation by randomised trial linked to economic evaluation. However evaluations of policy initiatives tend to eschew experimental designs in favour of interpretative perspectives which rarely allow the economic evaluation methods used in clinical trials. As evidence of the cost effectiveness of such initiatives is critical in informing policy, it is important to explore whether conventional economic evaluation methods apply to experimental evaluations of policy initiatives.METHODS: We used mixed methods based on a quasi-experimental design to evaluate a policy initiative whose aim was to expedite the modernisation of gastroenterology endoscopy services in England. We compared 10 sites which had received funding and support to modernise their endoscopy services with 10 controls. We collected data from five waves of patients undergoing endoscopy. The economic component of the study compared sites by levels of investment in modernisation and patients' use of health service resources, time off work and health related quality of life.RESULTS: We found no statistically significant difference between intervention and control sites in investment in modernisation or any patient outcome including health.CONCLUSIONS: This study highlights difficulties in applying the rigour of a randomised trial and associated technique of economic evaluation to a policy initiative. It nevertheless demonstrates the feasibility of using this approach although further work is needed to demonstrate its generalisability in other applications. The present application shows that the small incentives offered to intervention sites did not enhance modernisation of gastroenterology endoscopy services or improve patient outcomes. Journal Article Cost Effectiveness and Resource Allocation 12 1 7 31 3 2014 2014-03-31 10.1186/1478-7547-12-7 COLLEGE NANME Swansea Centre for Health Economics COLLEGE CODE HHE Swansea University 2015-04-21T17:23:58.2404741 2015-04-21T17:18:48.8848065 Faculty of Medicine, Health and Life Sciences School of Health and Social Care David Cohen 1 M Alam 2 Nishma Patel 3 Wai-Yee Cheung 4 John G Williams 5 Ian T Russell 6 Fasihul Alam 7
title Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
spellingShingle Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
Fasihul Alam
title_short Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
title_full Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
title_fullStr Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
title_full_unstemmed Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
title_sort Economic evaluation of policy initiatives in the organisation and delivery of healthcare: a case study of gastroenterology endoscopy services
author_id_str_mv 642c9290a11352cb60741fc2b1004f6d
author_id_fullname_str_mv 642c9290a11352cb60741fc2b1004f6d_***_Fasihul Alam
author Fasihul Alam
author2 David Cohen
M Alam
Nishma Patel
Wai-Yee Cheung
John G Williams
Ian T Russell
Fasihul Alam
format Journal article
container_title Cost Effectiveness and Resource Allocation
container_volume 12
container_issue 1
container_start_page 7
publishDate 2014
institution Swansea University
doi_str_mv 10.1186/1478-7547-12-7
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 0
active_str 0
description BACKGROUND: Complex clinical interventions are increasingly subject to evaluation by randomised trial linked to economic evaluation. However evaluations of policy initiatives tend to eschew experimental designs in favour of interpretative perspectives which rarely allow the economic evaluation methods used in clinical trials. As evidence of the cost effectiveness of such initiatives is critical in informing policy, it is important to explore whether conventional economic evaluation methods apply to experimental evaluations of policy initiatives.METHODS: We used mixed methods based on a quasi-experimental design to evaluate a policy initiative whose aim was to expedite the modernisation of gastroenterology endoscopy services in England. We compared 10 sites which had received funding and support to modernise their endoscopy services with 10 controls. We collected data from five waves of patients undergoing endoscopy. The economic component of the study compared sites by levels of investment in modernisation and patients' use of health service resources, time off work and health related quality of life.RESULTS: We found no statistically significant difference between intervention and control sites in investment in modernisation or any patient outcome including health.CONCLUSIONS: This study highlights difficulties in applying the rigour of a randomised trial and associated technique of economic evaluation to a policy initiative. It nevertheless demonstrates the feasibility of using this approach although further work is needed to demonstrate its generalisability in other applications. The present application shows that the small incentives offered to intervention sites did not enhance modernisation of gastroenterology endoscopy services or improve patient outcomes.
published_date 2014-03-31T03:24:39Z
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score 11.012678

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