IDEAS home Printed from https://ideas.repec.org/
MyIDEAS: Login to save this paper or follow this series

Coverage with evidence development, only in research, risk sharing or patient access scheme? A framework for coverage decisions

  • Simon Walker

    (Centre for Health Economics, University of York, UK)

  • Mark Sculpher

    (Centre for Health Economics, University of York, UK)

  • Karl Claxton

    (Centre for Health Economics, University of York, UK and Department of Economics and Related Studies, University of York, UK)

  • Steve Palmer

    (Centre for Health Economics, University of York, UK)

Registered author(s):

    Context Until recently, purchasers’ options regarding whether to pay for the use of technologies have been binary in nature: a treatment is covered or not covered. However, policies have emerged which expand the options - for example, linking coverage to evidence development, an option increasingly used for new treatments with limited/uncertain evidence. There has been little effort to reconcile the features of technologies with the available options in a way that reflects purchasers’ ranges of authority. Methods We developed a framework within which different options can be evaluated. We distinguished two sources of value in terms of health: the value of the technology per se; and the value of reducing decision uncertainty. The costs of reversing decisions are also considered. Findings Purchasers should weigh the expected benefits of coverage against the possibility the decision may need to be reversed and the possibility adoption will hinder/prevent evidence generation. Based on the purchaser’s range of authority and the features of the technology different decisions may be appropriate. The framework clarifies the assessments needed to establish the appropriateness of different decisions. A taxonomy of coverage decisions consistent with the framework is suggested. Conclusions A range of coverage options permit paying for use of promising medical technologies despite their limited/uncertain evidence bases. It is important that the option chosen be based upon not only the expected value of a technology but also the value of further research, the anticipated effect of coverage on further research, and the costs associated with reversing the decision.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP77_a_framework_for_coverage_decisions_only_in_research_evidence_development.pdf
    File Function: First version, 2012
    Download Restriction: no

    Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 077cherp.

    as
    in new window

    Length: pages
    Date of creation: Apr 2012
    Date of revision:
    Handle: RePEc:chy:respap:77cherp
    Contact details of provider: Postal: York Y010 5DD
    Phone: (01904) 321401
    Fax: (0)1904 323759
    Web page: http://www.york.ac.uk/che
    Email:


    More information through EDIRC

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    as in new window
    1. Palmer, Stephen & Smith, Peter C., 2000. "Incorporating option values into the economic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 19(5), pages 755-766, September.
    2. Claxton, Karl, 1999. "The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 18(3), pages 341-364, June.
    3. Brazier, John & Ratcliffe, Julie & Salomon, Joshua A. & Tsuchiya, Aki, 2007. "Measuring and Valuing Health Benefits for Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198569824, March.
    4. Martin, Stephen & Rice, Nigel & Smith, Peter C., 2008. "Does health care spending improve health outcomes? Evidence from English programme budgeting data," Journal of Health Economics, Elsevier, vol. 27(4), pages 826-842, July.
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:chy:respap:77cherp. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Frances Sharp)

    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 references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link 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 profile, as there may be some citations waiting for confirmation.

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

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.