IDEAS home Printed from https://ideas.repec.org/a/spr/pharme/v24y2006i2p101-109.html
   My bibliography  Save this article

Lean Systems Approaches to Health Technology Assessment

Author

Listed:
  • John Bridges

Abstract

Many countries now use health technology assessment (HTA) to review new and emerging technologies, especially with regard to reimbursement, pricing and/or clinical guidelines. One of the common, but not universal, features of these systems is the use of economic evaluation, normally cost-effectiveness analysis (CEA), to confirm that new technologies offer value for money. Many have criticised these systems as primarily being concerned with cost containment, rather than advancing the interests of patients or innovators. This paper calls into question the underlying principles of CEA by arguing that value in the healthcare system may in fact be unconstrained. It is suggested that ‘lean management principles’ can be used not only to trim waste from the health system, but as a method of creating real incentives for innovation and value creation. Following the lean paradigm, this value must be defined purely from the patients’ perspective, and the entire health system needs to work towards the creation of such value. This paper offers as a practical example a lean approach to HTA, arguing that such an approach would lead to better incentives for innovation in health, as well as more patient-friendly outcomes in the long run. Copyright Adis Data Information BV 2006

Suggested Citation

  • John Bridges, 2006. "Lean Systems Approaches to Health Technology Assessment," PharmacoEconomics, Springer, vol. 24(2), pages 101-109, December.
    • Handle: RePEc:spr:pharme:v:24:y:2006:i:2:p:101-109
    DOI: 10.2165/00019053-200624002-00011
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.2165/00019053-200624002-00011
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.2165/00019053-200624002-00011?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Leys, Mark, 2003. "Health care policy: qualitative evidence and health technology assessment," Health Policy, Elsevier, vol. 65(3), pages 217-226, September.
    2. Mooney, Gavin, 1998. ""Communitarian claims" as an ethical basis for allocating health care resources," Social Science & Medicine, Elsevier, vol. 47(9), pages 1171-1180, November.
    3. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
    4. Banta, David, 2003. "The development of health technology assessment," Health Policy, Elsevier, vol. 63(2), pages 121-132, February.
    5. Cookson, Richard & Hutton, John, 2003. "Regulating the economic evaluation of pharmaceuticals and medical devices: a European perspective," Health Policy, Elsevier, vol. 63(2), pages 167-178, February.
    6. Ryan, Mandy, 1999. "Using conjoint analysis to take account of patient preferences and go beyond health outcomes: an application to in vitro fertilisation," Social Science & Medicine, Elsevier, vol. 48(4), pages 535-546, February.
    7. David M. Kent & A. Mark Fendrick & Kenneth M. Langa, 2004. "New and Dis-Improved: On the Evaluation and Use of Less Effective, Less Expensive Medical Interventions," Medical Decision Making, , vol. 24(3), pages 281-286, June.
    8. Thomas H. Klier, 1993. "Lean manufacturing: understanding a new manufacturing system," Chicago Fed Letter, Federal Reserve Bank of Chicago, issue Mar.
    9. Birch, Stephen & Gafni, Amiram, 1994. "Cost-effectiveness ratios: in a league of their own," Health Policy, Elsevier, vol. 28(2), pages 133-141, May.
    10. Karen Gerard & Gavin Mooney, 1993. "Qaly league tables: Handle with care," Health Economics, John Wiley & Sons, Ltd., vol. 2(1), pages 59-64, April.
    11. Fulop, Naomi & Allen, Pauline & Clarke, Aileen & Black, Nick, 2003. "From health technology assessment to research on the organisation and delivery of health services: addressing the balance," Health Policy, Elsevier, vol. 63(2), pages 155-165, February.
    12. J. F. P. Bridges & M. Stewart & M. T. King & K. van Gool, 2002. "Adapting portfolio theory for the evaluation of multiple investments in health with a multiplicative extension for treatment synergies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 3(1), pages 47-53, March.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. John Bridges & Elizabeth Kinter & Lillian Kidane & Rebekah Heinzen & Colleen McCormick, 2008. "Things are Looking up Since We Started Listening to Patients," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 1(4), pages 273-282, October.
    2. John Bridges & Christopher Carswell, 2008. "Honoring Pioneers in Patient-Centered Outcomes Research," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 1(1), pages 5-6, January.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pieter H. M. van Baal & Talitha L. Feenstra & Rudolf T. Hoogenveen & G. Ardine de Wit & Werner B. F. Brouwer, 2007. "Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect’ cost–utility ratio," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 421-433, April.
    2. Rutten, Frans, 1996. "Economic evaluation and health care decision-making," Health Policy, Elsevier, vol. 36(3), pages 215-229, June.
    3. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    4. Velasco Garrido, Marcial & Gerhardus, Ansgar & Røttingen, John-Arne & Busse, Reinhard, 2010. "Developing Health Technology Assessment to address health care system needs," Health Policy, Elsevier, vol. 94(3), pages 196-202, March.
    5. Mooney, Gavin, 2005. "Communitarian claims and community capabilities: furthering priority setting?," Social Science & Medicine, Elsevier, vol. 60(2), pages 247-255, January.
    6. A. Chapman & C. Taylor & A. Girling, 2014. "Are the UK Systems of Innovation and Evaluation of Medical Devices Compatible? The Role of NICE’s Medical Technologies Evaluation Programme (MTEP)," Applied Health Economics and Health Policy, Springer, vol. 12(4), pages 347-357, August.
    7. Lindholm, Lars & Hallgren, C. -G. & Boman, Kurt & Markgren, Kenth & Weinehall, Lars & Ogren, J. -E., 1999. "Cost-effectiveness analysis with defined budget: how to distribute resources for the prevention of cardiovascular disease?," Health Policy, Elsevier, vol. 48(3), pages 155-170, August.
    8. Salkeld, Glenn & Davey, Peter & Arnolda, Gaston, 1995. "A critical review of health-related economic evaluations in Australia: implications for health policy," Health Policy, Elsevier, vol. 31(2), pages 111-125, February.
    9. Elamin H. Elbasha, 2005. "Risk aversion and uncertainty in cost‐effectiveness analysis: the expected‐utility, moment‐generating function approach," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 457-470, May.
    10. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    11. Stephen Birch & Amiram Gafni, 2012. "Decision Rules in Economic Evaluation Revisited," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 49, Edward Elgar Publishing.
    12. James Mason & Mike Drummond, 1995. "The DH register of cost-effectiveness studies: a review of study content and quality," Working Papers 128chedp, Centre for Health Economics, University of York.
    13. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    14. Goven, Joanna, 2008. "Assessing genetic testing: Who are the "lay experts"?," Health Policy, Elsevier, vol. 85(1), pages 1-18, January.
    15. Johannesson, Magnus, 1995. "On the estimation of cost-effectiveness ratios," Health Policy, Elsevier, vol. 31(3), pages 225-229, March.
    16. Park, Chong Hyun & Lim, Heejong, 2021. "A parametric approach to integer linear fractional programming: Newton’s and Hybrid-Newton methods for an optimal road maintenance problem," European Journal of Operational Research, Elsevier, vol. 289(3), pages 1030-1039.
    17. Javad Moradpour & Aidan Hollis, 2021. "The economic theory of cost‐effectiveness thresholds in health: Domestic and international implications," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1139-1151, May.
    18. Charles Cunningham & Ken Deal & Yvonne Chen, 2010. "Adaptive Choice-Based Conjoint Analysis," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 3(4), pages 257-273, December.
    19. Wang, Yi & Rattanavipapong, Waranya & Teerawattananon, Yot, 2021. "Using health technology assessment to set priority, inform target product profiles, and design clinical study for health innovation," Technological Forecasting and Social Change, Elsevier, vol. 172(C).
    20. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharme:v:24:y:2006:i:2:p:101-109. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.