Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?

Jun 1, 2021, 00:00
10.1016/j.jval.2021.01.014
https://www.valueinhealthjournal.com/article/S1098-3015(21)00148-0/fulltext
Title : Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(21)00148-0&doi=10.1016/j.jval.2021.01.014
First page : 795
Section Title : HEALTH POLICY ANALYSIS
Open access? : Yes
Section Order : 795

Objectives

To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application.

Methods

A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results.

Results

Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used.

Conclusions

MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision & Deliberative Processes
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Health Technology Assessment
  • Study Approaches
  • Value of Information
Tags :
  • cost-utility analysis
  • health services research
  • local decision-making
  • multi-criteria decision analysis
  • new models of care
Regions :
  • Eastern and Central Europe
ViH Article Tags :