Should these “minimal competencies” be de-fined?

1. Questions pertaining to who should be trained, how training should be performed, and what level of training is required need to be an-swered.
2. The necessity of credentialing practitioners and users of health economic research needs to be assessed.
3. There is need to improve the way information about training opportunities is disseminated.

A number of training opportunities specifically related to economic evaluation in healthcare al-ready exist, including self-study continuing educa-tion (CE) programs, sponsored workshops, and CE programs. Certificate programs are also avail-able. For example, the American Society of Health System Pharmacists (ASHP) Competitive Edge Program includes self-study (30 hours), lecture, simulation exercises (4.5 days), and a research project (3–4 months). University-based certificate programs, graduate degrees, and minor concentra-tions exist in the field of health economics and health services research. Pharmacoeconomics fel-lowships are also available. Various types of Mas-ter’s degrees (MS, MBA, MPH), medical training (MD), and doctoral training (PharmD, PhD, DrPH) in a number of related also contribute sig-nificantly to the knowledge base for training in health economics disciplines (Table 1).

Recommendations and Next Steps

Recommendations are proposed in the following domains:

1. levels of expertise;
2. educational infrastructure awareness;
3. educational infrastructure enhancement;
4. proper training “match”;
5. balance between didactic and experiential edu-cation;

Table 1 Examples of the many different academic disciplines contributing to expertise in health economics

Accounting	Management science
Business	Marketing
Economics	Medicine
Engineering	Nursing
Environmental forecasting	Pharmacy
Epidemiology	Psychometrics
Finance	Public health
Health administration	Sociology
Health services research	Statistics/Biostatistics

1. credentialing;
2. standardization of training and certification.

Levels of Expertise

Three levels of expertise among individuals in-volved in the practice and application of health economics were identified by the panel, including:

(1) awareness, (2) application, and (3) conceptual-ization.

A list of these different levels of expertise is shown in Table 2. Awareness is defined as an ex-posure to and factual knowledge of the discipline, allowing trained individuals to converse with oth-ers, understand research data and ask for help in the field. Individuals trained at the application level should be able to evaluate and compare data critically and make decisions based on health eco-nomic research information. In addition, they should have the ability to initiate studies based on standard methodologies. For the conceptualiza-tion level of expertise, trained individuals would have the ability to create new methodology, de-velop theory, and assimilate relevant methodolo-gies and theories from related disciplines.

Educational Infrastructure Awareness

The panel recommends developing access to de-tailed information about available educational programs in the field of health economics. Identifi-cation of relevant educational resources outside of the field should be part of this awareness. A Web site would be an invaluable tool to disseminate in-formation on availability of all existing training programs.

Educational Infrastructure Enhancement

Relevant educational resources outside of health economics should be utilized to enhance the edu-cational infrastructure. With respect to health eco-nomics training, a Web site and other available communication technologies could be used to of-fer educational support; this may include ques-tion-answer potential on-line and distance learn-ing. Sponsored formal training programs were also proposed. These would be competitively se-lected and targeted to different levels. The offering of higher level programs should be encouraged, as well as short courses at society meetings and 1- to 2-week training programs.

To assure relevance for all stakeholders, a three-way partnership with managed care, indus-try, and academia needs to be established for fel-lowship and residency programs. There is also a need for official funding and consideration of faculty incentives. Nationally known training sites and credible “train the trainer” programs would also contribute to the infrastructure.

Table 2	Levels of competency and corresponding training needs in health economics
			Level of training
Level of competency		Continuing education	Experiential training/Certificate	Fellowships	Formal degree
Awareness		√
Industry field force
Healthcare practitioners		√
Healthcare administrators		√
Clinical and marketing industry team		√
Patient groups		√
Benefits managers		√
Application			√	√
Decision-makers for populations
Applied researcher			√	√	√
Conceptualize				√	√
Academic/faculty
Senior industry scientists				√	√
Senior research consultant				√	√

The International Society for Pharmacoeco-nomics and Outcomes Research (ISPOR) has a unique role to play in enhancing the education-al infrastructure for health economics. Through ISPOR, various types of training could be offered, especially for those at higher levels. Faculty train-ers should be recognized experts in the field. ISPOR may also wish to join forces with other or-ganizations to expand programs.

Proper Training “Match”

Degree programs should accommodate multidisci-plinary participants through the availability of prerequisite trainings and flexible core course of-ferings. Potential students of programs at the awareness training level should be made aware of program requirements. ISPOR identification of training programs would be helpful.

Balance between Didactic and Experiential Education

Programs, regardless of level, are enhanced by the incorporation of real-world data and exposure. The panel recommends that training include expe-rience in a real-life setting, with case studies and “live” data sets. Establishment of collaborative re-lationships between academia, industry, and man-aged care organizations would be necessary to en-able optimal training experiences.

Credentialing of Individuals

The development of a credentialing process should be a long-term goal of ISPOR to establish stan-dards for the field. In the short term, for those al-ready active in the field, the use of a professional portfolio demonstrating accomplishment in the field is recommended in lieu of credentialing.

Standards of Training and Certification

It is recommended that ISPOR play a leadership role in standardizing training and certification through a three-step process:

1. Step 1: Develop guidelines for postprofessional degree training.
2. Step 2: Accredit pharmacoeconomic residen-cies and fellowships.
3. Step 3: Establish collaborations with other or-ganizations to expand accreditation to other relevant residencies.

Summary

At the present time there is a strong demand for, and short supply of, qualified professionals in the field of health economics. Although a diversity of training opportunities exists for both decision-makers and researchers, the educational infra-structure is inadequate to satisfy the demand. Rec-ognizing the need for different levels of expertise, the panel recommends an effort be made to in-crease awareness of currently available training opportunities and to strengthen the number and quality of these programs. Credentialing and stan-dardization of training and certification are proposed as long-term goals in which the International Soci-ety for Pharmacoeconomics and Outcomes Re-search has a major role to play.

References