Quantifying short run cost-effectiveness during a gradual implementation process

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• 作者：Gijs van de Wetering (1)
  Willem H. Woertman (1)
  Andre L. Verbeek (1)
  Mireille J. Broeders (1)
  Eddy M. M. Adang (1)
  
• 关键词：Economic evaluation ; Technology substitution ; Short run efficiency ; Implementation ; Cost behaviour ; D01 ; D24 ; D60 ; D61
• 刊名：The European Journal of Health Economics
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：14
• 期：6
• 页码：911-918
• 全文大小：
• 作者单位：Gijs van de Wetering (1)
  Willem H. Woertman (1)
  Andre L. Verbeek (1)
  Mireille J. Broeders (1)
  Eddy M. M. Adang (1)
  
  1. Department of Epidemiology, Biostatistics, and HTA, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
  
• ISSN：1618-7601

文摘

This paper examines the short run inefficiencies that arise during gradual implementation of a new cost-effective technology in healthcare. These inefficiencies arise when health gains associated with the new technology cannot be obtained immediately because the new technology does not yet supply all patients, and when there is overcapacity for the old technology in the short run because the supply of care is divided among two mutually exclusive technologies. Such efficiency losses are not taken into account in standard textbook cost-effectiveness analysis in which a steady state is presented where costs and effects are assumed to be unchanging over time. A model is constructed to quantify such short run inefficiencies as well as to inform the decision maker about the optimal implementation pattern for the new technology. The model operates by integrating the incremental net benefit equations for both the period of co-existence of mutually exclusive technologies and the period after complete substitution of the old technology. It takes into account the rate of implementation of the new technology, depreciation of capital of the old technology as well as the demand curves for both technologies. The model is applied to the real world case of converting from screen film to digital mammography in the Netherlands.