PUTTING THEORY INTO PRACTICE

PUTTING THEORY INTO PRACTICE SYDNEY HEALTH ECONOMICS SHORT COURSE 2015 HEALTH ECONOMICS FROM THEORY TO PRACTICE: OPTIMALLY INFORMING RELATED DECISIONS OF REIMBURSEMENT, RESEARCH AND REGULATION IN PRACTICE A THREE-DAY COURSE Conducted by Professor Simon Eckermann and Dr Nikki McCaffrey 1-3 April 2015 Sydney Business School, Circular Quay

COURSE DETAILS SUITABLE FOR Health policy researchers, health policy makers, evaluators of health technology assessment, health economists, research active health care professionals. WHAT IS THE COURSE? The course teaches best practice for optimally addressing joint reimbursement, research and regulation (efficiency monitoring, funding pricing) decisions and policies associated with cost effectiveness analysis, health technology assessment and health system practice. OBJECTIVES Using seminars and tutorial-based learning with methods provided in Excel spreadsheets, the course provides participants with the principles, practical skills, methods and software to: 1. Robustly and appropriately evaluate cost effectiveness of alternative health care interventions (Briggs, O Brien and Blackhouse 2002; Willan and Briggs 2006) or health promotion and prevention strategies (Sheill at al. 2008; Hawe et al. 2009; Eckermann et. al.2014) and related policies (Eckermann 2014) consistent with budget constrained maximizing of societal net benefit (Pekarsky 2012; Eckermann and Pekarsky 2014). 2. Undertake unbiased analysis of cost effectiveness evidence and avoid common inferential fallacies in health economic analysis in processes of evidence synthesis (Briggs and O Brien 2001; Eckermann, Coory and Willan 2009) and evidence translation (O Brien 1996; Eckermann, Coory and Willan 2011) 3. Undertake research design using value of information methods to maximise expected value relative to cost of research allowing for appropriate decision context, including time, opportunity costs and option value of delay, and imperfect implementation (Eckermann and Willan 2007, 2008, 2009, 2013; Eckermann, Karnon and Willan 2010; Kent, Briggs, Eckermann and Berry 2013; Willan and Eckermann 2010, 2012) 4. Best compare cost effectiveness of multiple strategies with use of expected net-loss curves and frontiers, which directkly and simply inform societal decision making of optimal strategies for reimbursement at any threshold value with current evidence and the potential future value of future research (Eckermann Briggs and Willan 2008; Eckermann and Willan 2011). 5. Best compare cost effectiveness of multiple outcomes under uncertainty (McCaffrey 2012; McCaffrey et al 2013, 2014), critical for comparisons of areas such as palliative care, but also transparency, generalizability and robust decision interpretation of events and utility weights underlying quality adjusted life year analysis. 6. Undertake efficiency measurement and funding across health-care providers consistent with maximizing health system net benefit (Eckermann 2004; Eckermann and Coelli 2013). The NBCT method naturally extends multiple strategy methods in HTA (see 4 above) to enable budget constrained net benefit maximizing quality of care incentive in practice, while preventing cost-shifting and cream skimming incentives.

KEY REFERENCES COVERED Briggs A., O Brien B. The Death of Cost Minimization Analysis, Health Economics, 2001;10:179 184. Briggs A., O Brien B., and Blackhouse G. Thinking outside the box: recent advances in the analysis and presentation of Uncertainty in cost effectiveness studies. Annual Review of Public Health, 2002; 23: 377 401. Eckermann S. Over and underservicing: further reasons to scrap the GP co-payment. The Conversation, August 7 2014. http://theconversation.com/over-andunder-servicing-further-reasons-to-scrap-the-gp-copayment-30199. Eckermann S. Avoiding a health system hernia and the associated outcomes and costs. ANZJ Public Health. 2014; 38(4): 303 305. Eckermann S., Dawber J., Yateman H., Quinsey K., Morris D. Evaluating return on investment in a school-based health promotion and prevention program: the investment multiplier for the Stephanie Alexander Kitchen Garden National Program. Social Science and Medicine. 2014; 114: 103-112. DOI: 10.1016/j.socscimed.2014.05.056. Eckermann S., Pekarsky B. Can the real opportunity cost stand up: displaced services the straw man outside the room. PharmacoEconomics. 2014; 32(4): 319 325. http:// www.springerlink.com/openurl.asp?genre=article&id=d oi:10.1007/s40273-014-0140-3. Eckermann, S., Coelli, T. 2013. Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice. Social Science & Medicine. 76: 159 168. Eckermann, S., Willan, A. 2013. Optimal global VOI trials: better aligning manufacturer and decision maker interest and enabling feasible risk sharing. PharmacoEconomics. 31: 393 401. Eckermann, S., Willan, A. 2011. Presenting evidence and summary measures to best inform societal decisions when comparing multiple strategies. PharmacoEconomics. 29(7): 563 577. Eckermann, S., Coory M, Willan A. 2011. Consistently estimating absolute risk difference when translating evidence to jurisdictions of interest. PharmacoEconomics. 21(10): 1183 1195. doi:10.1002/hec.1781. Eckermann, S., Karnon, J., Willan, A. 2010. The value of Value of Information: best informing research design and prioritization using current methods. PharmacoEconomics. 28(9): 699 709. Eckermann, S., Willan, A.R. 2009. Globally optimal trial design for local decision making. Health Economics. 18: 203 216. Eckermann S., Coory M., Willan A.R. 2009. Indirect comparison: relative risk fallacies and odds solution Journal of Clinical Epidemiology. 62: 1031 1036. Eckermann, S., Briggs, A., Willan, A.R. 2008. Health Technology Assessment in the Cost-Disutility Plane. Medical Decision Making. 28: 172 181. Eckermann, S., Willan, A.R. 2008, Time and Expected Value of Sample Information Wait for No Patient. Value in Health. 11: 522 526. Eckermann, S., Willan, A.R. 2008, The Option Value of Delay in Health Technology Assessment. Medical Decision Making. 28: 300 305. Eckermann, S., Willan, A.R. 2007, Expected Value of Information and Decision Making in HTA. Health Economics. 16: 195 209. Kent S., Briggs A., Eckermann S., Berry C. Are value of information methods ready for prime time? International Journal for Technolgy Assessment in Health Care. 2013; 29 (4): 435 442. McCaffrey N., Skuza P., Breaden K., Eckermann S., Hardy J., Oaten S., Briffa M., Currow D. Preliminary development and validation of a new end-of-life patient-reported outcome measure assessing the ability of patients to finalise their affairs at the end of life. PLoS ONE 2014; 9(4): e94316. doi:10.1371/journal.pone.0094316. McCaffrey N., Agar M., Harlum J., Karnon J., Currow D., Eckermann S. Is home-based palliative care cost effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot. BMJ Supportive & Palliative Care. 2013. doi:10.1136/bmjspcare-2012-000361. O Brien B. 1996. Economic evaluation of pharmaceuticals. Frankenstein s monster or vampire of trials? Med Care. 1996 Dec; 34 (12 Suppl): DS99-108. Willan, A.R., Briggs, A. 2006. Statistical analysis of cost effectiveness data. Wiley. Willan, A., Eckermann, S. 2012. Expected value of information and pricing new health care interventions. PharmacoEconomics. 30(6): 447 459. Willan, A.R., Eckermann, S. 2010. Optimal clinical trial design using value of information with imperfect implementation. Health Economics. 19: 549 561. Willan, A.R. 2008. Optimal sample size determinations from an industry perspective based on the expected value of information. Clinical Trials. 5: 587 594. Eckermann, S., Willan, A.R. 2007, Expected Value of Information and Decision Making in HTA. Health Economics. 16: 195 209. Willan, A.R., Briggs, A. 2006. Statistical analysis of cost effectiveness data. Wiley.

DAY 1: REIMBURSEMENT: PRINCIPLES AND METHODS FOR OPTIMISING DECISION MAKING UNDER UNCERTAINTY 8.45 9.00 Arrival with tea and coffee 9.00 10.30 Principles and practice of economic evaluation in health technology assessment: coverage, comparability, opportunity costs and thinking outside the box 10.30 10.45 Morning Tea Break 10.45 12.15 Frankenstein s Monster or Vampire of Trials: avoiding inferential fallacies in evidence synthesis and translation 12.15 1.00 Lunch 1.00 2.00 Decision Analysis, and Decision Tree Methods 2.15 2.45 Extrapolating cost-effectiveness evidence for a jurisdiction of interest 2.45 3.15 Afternoon Tea Break 3.15 4.15 Principles and practical methods for economic evaluation of community based health promotion and prevention programs 4.15 5.00 Beyond QALYs the importance of multiple outcome domains, particularly in palliative care

DAY 2: RESEARCH AND REIMBURSEMENT UNDER UNCERTAINTY: OPTIMAL TRIAL DESIGN WITHIN AND ACROSS JURISDICTIONS 9.00 10.00 Probabilistic Sensitivity Analysis (PSA) from parameter uncertainty to net benefit uncertainty 10.00 11.00 Joint Research and reimbursement decisions: Value of information (VoI) to decision makers & principles for efficient trial design 11.00 11.15 Morning Tea Break 11.15 12.15 Optimal global trial design and decision making 12.15 12.45 VOI and pricing with optimal global trial design: Better aligning manufacturer and decision maker interest and enabling feasible risk sharing. 12.45 1.30 Lunch 1.30 2.30 Best informing societal decisions when comparing two or more strategies: the cost-disutility plane and expected net loss curves and frontiers 2.30 3.00 Tutorial: ENL curves and frontiers 3.00 3.30 Afternoon Tea Break 3.30 5.00 Multiple outcome comparisons robust presentation and summary measures DAY 3: RESEARCH, REIMBURSEMENT AND REGULATION IN PRACTICE 9.00 11.00 The net benefit correspondence theorem: creating incentives for evidence based medicine in practice 11.00 11.15 Morning Tea Break 11.15-12.15 Tutorial: Comparing provider efficiency in practice consistent with maximising benefit 12.15 1.00 Lunch 1.00 2.00 Bridging the Silos: maximising quality within a budget 2.00-3.00 Opportunity cost of reimbursement: the economically meaningful threshold value 3.00 3.30 Afternoon Tea Break 3.30 4.30 A critique of and alternative to the 2014 Federal budget proposals: the importance of primary care, disease prevention and health promotion

SPEAKERS DR NIKKI MCCAFFREY Faculty of Medicine, Nursing and Health Sciences, Flinders University Nikki McCaffrey is a health economist with a pharmacy background and over ten years experience in health technology assessment and health economic analysis in palliative care. She works for Flinders Health Economics Group and the Palliative Care Clinical Studies Collaborative (PaCCSC), a national collaboration of researchers engaged in Phase III studies in palliative care. Dr McCaffrey has been successful as: a researcher, applying qualitative and quantitative approaches in palliative care economic evaluation, outcome measurement, the quality use of medicines, healthy ageing and epidemiology; a health technology evaluator, critiquing applications to the Australian Pharmaceutical Benefits Advisory Committee; and a pharmaceutical adviser, providing guidance to over 40 GPs regarding the cost-effective use of medicines. Dr McCaffrey is an investigator on competitive research grants totalling more than A$4 million. Her original research includes: Comparison in cost-disutility space to best inform risk neutral or risk averse decision makers when comparing more than two strategies with multiple outcomes in health technology assessment; Outcome measurement in palliative care economic evaluations, including the development of disease specific preference based economic measures; Evaluation of community models of palliative care; and Development of discrete choice attributes from qualitative data. Dr McCaffrey is an advisory group member for the Specialist Palliative Care and Advance Planning Advisory Service for Aged Care, a national project funded by the government ($14.95 mill), a research executive member of the South Australian Palliative Care Clinical Network, and a PaCCSC Scientific Committee board member. Formal academic qualifications include an honours degree in pharmacy, postgraduate diplomas in clinical pharmacy and health economics and policy, a master s degree in prescribing sciences and pharmacoeconomics, and a doctoral degree in health economics.

SPEAKERS PROFESSOR SIMON ECKERMANN Sydney Business School, University of Wollongong Simon Eckermann is Professor of Health Economics at the Australian Health Services Research Institute and University of Wollongong. He was previously Professor at Flinders University and Senior Health Economist at the NHMRC Clinical Trial Centre, Sydney University. He has extensive experience in undertaking original and applied research with health economic methods in Health Technology Assessment (HTA) and practice. His original research includes: (i) (ii) (iii) (iv) methods for consistently estimating absolute risk differences to overcome inferential fallacies identified with use of relative risk in indirect comparisons and translating evidence; the expected net loss frontier and comparison on the cost-disutility plane to best inform risk neutral or risk averse decision makers when comparing more than two strategies in health technology assessment; a correspondence method allowing efficiency measures of health care providers or health systems in practice consistent with the maximisation of net benefit underlying evidence based care; and value of information methods for optimally informing joint reimbursement and research decisions by society decision makers and industry locally and globally with Professor Willan (www.andywillan.com). More generally, this research has demonstrated links between optimal decision making in research, reimbursement and regulation in practice. Related principles and methods have been taught by Professor Eckermann to more than 500 students from a wide range of clinical, research, policy and health technology assessment backgrounds participants since 2000, with the Health Economics from Theory to Practice course running since 2005 consistently rated by participants as the best course of its type internationally. Professor Eckermann has also actively sat on and undertaken guideline revision and health economics educational activities for National decision bodies including the PBAC Economic Sub-Committee (2005 2010), Palliative Care Trials Scientific Committee (2006 2014), and Prostheses List Advisory Committee (2010 2012). He is a CI on competitive research grants totaling more than A$22 million.

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