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  1. Article ; Online: Reply to Comment on "A Framework for Fair Pricing of Medicines".

    Paulden, Mike

    PharmacoEconomics

    2024  Volume 42, Issue 5, Page(s) 607–609

    MeSH term(s) Drug Costs ; Humans ; Costs and Cost Analysis ; Pharmaceutical Preparations/economics
    Chemical Substances Pharmaceutical Preparations
    Language English
    Publishing date 2024-03-13
    Publishing country New Zealand
    Document type Letter ; Comment
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-024-01369-9
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  2. Article ; Online: A Framework for the Fair Pricing of Medicines.

    Paulden, Mike

    PharmacoEconomics

    2023  Volume 42, Issue 2, Page(s) 145–164

    Abstract: As high-cost medicines put increasing pressure on public health care budgets, the need to identify 'fair' prices for medicines has never been greater. This paper proposes a framework, built upon fundamental economic principles, that allows for the ... ...

    Abstract As high-cost medicines put increasing pressure on public health care budgets, the need to identify 'fair' prices for medicines has never been greater. This paper proposes a framework, built upon fundamental economic principles, that allows for the consideration of 'fair' prices for medicines. The framework incorporates key considerations from conventional supply-side and demand-side approaches for specifying a cost-effectiveness 'threshold', including the health opportunity cost borne by other patients ([Formula: see text]) and society's willingness to pay for marginal improvements in population health ([Formula: see text]). The costs incurred by manufacturers in developing and supplying new medicines are also considered, as are the incentives for manufacturers to strategically price up to any common price per unit of benefit (cost-effectiveness 'threshold') specified by the payer. The framework finds that, at any 'fair' price, a medicine's dynamically calculated incremental cost-effectiveness ratio (ICER) lies below [Formula: see text]. When pricing medicines collectively, the framework finds that a common price below [Formula: see text] is required to maximize population health (consumer surplus) or to maximize total welfare (consumer and producer surplus). This framework has important policy implications for payers who wish to improve population health outcomes from constrained health care budgets. In particular, existing approaches to 'value-based pricing' should be reconsidered to ensure that patients receive a 'fair' share of the resulting economic surplus.
    MeSH term(s) Humans ; Health Care Costs ; Drug Costs ; Budgets ; Cost-Benefit Analysis
    Language English
    Publishing date 2023-12-08
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-023-01325-z
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  3. Article ; Online: Correction to: Calculating and Interpreting ICERs and Net Benefit.

    Paulden, Mike

    PharmacoEconomics

    2020  Volume 38, Issue 10, Page(s) 1147

    Abstract: The original article can be found online. ...

    Abstract The original article can be found online.
    Language English
    Publishing date 2020-08-18
    Publishing country New Zealand
    Document type Published Erratum
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-020-00950-2
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  4. Article ; Online: Calculating and Interpreting ICERs and Net Benefit.

    Paulden, Mike

    PharmacoEconomics

    2020  Volume 38, Issue 8, Page(s) 785–807

    Abstract: For several decades, the incremental cost-effectiveness ratio has been routinely used by health technology assessment agencies around the world to summarise the results of economic evaluations of health interventions. Yet reporting and considering ... ...

    Abstract For several decades, the incremental cost-effectiveness ratio has been routinely used by health technology assessment agencies around the world to summarise the results of economic evaluations of health interventions. Yet reporting and considering incremental cost-effectiveness ratios is unnecessary. Alternative summary measures exist, based on the concept of 'net benefit'. The incremental cost-effectiveness ratio and measures of net benefit share several commonalities but some important distinctions. As a result, different methods are required to calculate and interpret incremental cost-effectiveness ratios compared to measures of net benefit. The aim of this practical application is to introduce readers to these methods, using a hypothetical example to illustrate key issues. First, the methods used to calculate each measure are described. Next, for each measure, consideration is made of whether and how each measure may be interpreted to perform the following tasks, each of which may be of interest to health technology assessment agencies: (1) identifying the single most cost-effective strategy; (2) ranking strategies from 'most' to 'least' cost-effective (on an ordinal scale); (3) determining the magnitude to which a strategy is more or less cost-effective than another strategy (on a cardinal scale); and (4) determining whether a strategy is more or less cost-effective following a sensitivity or scenario analysis. This practical application also introduces a novel approach for visually interpreting measures of net benefit using the cost-effectiveness plane, which addresses a number of limitations of the conventional cost-effectiveness 'efficiency frontier'. By the end of this practical application, readers should have an understanding of how to calculate and interpret each measure, as well as the relative strengths and limitations of each.
    MeSH term(s) Biomedical Technology/economics ; Cost-Benefit Analysis/methods ; Humans ; Technology Assessment, Biomedical/methods
    Language English
    Publishing date 2020-05-11
    Publishing country New Zealand
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-020-00914-6
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  5. Article ; Online: Why it's Time to Abandon the ICER.

    Paulden, Mike

    PharmacoEconomics

    2020  Volume 38, Issue 8, Page(s) 781–784

    MeSH term(s) Biomedical Technology/economics ; Cost-Benefit Analysis/methods ; Humans ; Technology Assessment, Biomedical/methods
    Language English
    Publishing date 2020-05-11
    Publishing country New Zealand
    Document type Editorial
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-020-00915-5
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  6. Article ; Online: Recent amendments to NICE's value-based assessment of health technologies: implicitly inequitable?

    Paulden, Mike

    Expert review of pharmacoeconomics & outcomes research

    2017  Volume 17, Issue 3, Page(s) 239–242

    Language English
    Publishing date 2017-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 2208481-2
    ISSN 1744-8379 ; 1473-7167
    ISSN (online) 1744-8379
    ISSN 1473-7167
    DOI 10.1080/14737167.2017.1330152
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  7. Article: Professional oral health care prevents mouth-lung infection in long-term care homes: a systematic review.

    Marusiak, Michelle J / Paulden, Michael / Ohinmaa, Arto

    Canadian journal of dental hygiene : CJDH = Journal canadien de l'hygiene dentaire : JCHD

    2023  Volume 57, Issue 3, Page(s) 180–190

    Abstract: Background: Nursing home-acquired pneumonia (NHAP) is the leading cause of mortality among residents in long-term care (LTC) homes. Aspiration pneumonia (AP) is one cause of NHAP. Professional oral health care (POHC) and daily mouth care can be ... ...

    Abstract Background: Nursing home-acquired pneumonia (NHAP) is the leading cause of mortality among residents in long-term care (LTC) homes. Aspiration pneumonia (AP) is one cause of NHAP. Professional oral health care (POHC) and daily mouth care can be effective in decreasing AP risk.
    Aim: To identify, appraise, synthesize, analyze, and interpret results on the effectiveness of onsite POHC interventions/programs delivered to LTC home residents in reducing oral disease and NHAP. To summarize the findings and provide recommendations for clinical work and future research.
    Methods: The PICO question addressed was, "In LTC home residents with oral health needs (P), is onsite POHC (I), compared to usual care (C), clinically effective in reducing dental disease and pneumonia/AP (O)?" Databases searched were PubMed, EMBASE (Ovid), CINAHL (Ebsco), Cochrane Library (Wiley), Web of Science, and the databases of the Centre for Reviews and Dissemination. Included were randomized controlled trials (RCTs), non-RCTs, and cross-sectional studies. PRISMA guidelines were followed and GRADE was used to assess the quality of studies.
    Results: Thirteen clinical effectiveness studies were included: 10 RCTs, 1 non-RCT, and 2 cross-sectional studies.
    Discussion: Better oral health and respiratory infection outcomes were found in the experimental groups who received an onsite POHC intervention compared to the control groups.
    Conclusion: There is moderate-to-strong evidence that onsite POHC in LTC homes, provided mostly by dental hygienists, is effective in preventing bacterial mouth infection, pneumonia, and AP.
    MeSH term(s) Humans ; Oral Health ; Long-Term Care ; Pneumonia/epidemiology ; Mouth/microbiology ; Pneumonia, Aspiration ; Communicable Diseases ; Lung ; Delivery of Health Care
    Chemical Substances N-hydroxy-2-aminopyrene (85964-28-9)
    Language English
    Publishing date 2023-10-01
    Publishing country Canada
    Document type Systematic Review ; Journal Article
    ISSN 1712-171X
    ISSN 1712-171X
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  8. Article ; Online: Modifying NICE's Approach to Equity Weighting.

    Paulden, Mike / McCabe, Christopher

    PharmacoEconomics

    2021  Volume 39, Issue 2, Page(s) 147–160

    Abstract: The UK's National Institute for Health and Care Excellence (NICE) recently launched a consultation on the methods it uses to evaluate new health technologies, and has highlighted the issue of how 'modifiers', including equity weights, should be ... ...

    Abstract The UK's National Institute for Health and Care Excellence (NICE) recently launched a consultation on the methods it uses to evaluate new health technologies, and has highlighted the issue of how 'modifiers', including equity weights, should be incorporated into its processes. The practice of applying equity weights to specific population subgroups, as a means for increasing the effective cost-effectiveness threshold for some new health technologies, is well established in health technology assessment. It is also the subject of extensive discussion in the academic literature. In this paper, we demonstrate that NICE's current approach to equity weighting has the effect of reducing both population health and equity-weighted population health, a fundamental problem that appears to place NICE in contravention of its principles and obligations. We consider two potential methods for modifying NICE's current approach to address this problem. We also consider the merits of NICE abandoning its current approach to equity weighting and adopting a standard 'net benefit' approach in its place. We find that adopting a standard 'net benefit' approach is the most desirable option, as it provides for the most transparency while avoiding specific issues that arise when attempting to modify NICE's current approach. Regardless of the approach NICE uses for equity weighting, we find that protecting the health of National Health Service patients requires that some new technologies be evaluated using an effective cost-effectiveness threshold lower than the 'supply-side' cost-effectiveness threshold. This poses a particular challenge for NICE, given its obligations under the 2019 'Voluntary Scheme' between the UK pharmaceutical industry, the National Health Service, and the UK Government. We conclude by making some recommendations as to how NICE can move forward with the use of 'modifiers' in its decision making.
    MeSH term(s) Cost-Benefit Analysis ; Humans ; Organizations ; State Medicine ; Technology Assessment, Biomedical
    Language English
    Publishing date 2021-01-31
    Publishing country New Zealand
    Document type Journal Article
    ZDB-ID 1100273-6
    ISSN 1179-2027 ; 1170-7690
    ISSN (online) 1179-2027
    ISSN 1170-7690
    DOI 10.1007/s40273-020-00988-2
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  9. Article: Outcomes of Prophylactic Peritoneal Dialysis Catheter Insertion in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.

    Ulrich, Emma H / Bedi, Prabhjot K / Alobaidi, Rashid / Morgan, Catherine J / Paulden, Mike / Zappitelli, Michael / Bagshaw, Sean M

    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

    2024  

    Abstract: Objectives: The objective of this Prospective Register of Systematic Reviews (CRD42022384192) registered systematic review and meta-analysis was to determine whether prophylactic peritoneal dialysis (PD) catheter insertion at the time of pediatric ... ...

    Abstract Objectives: The objective of this Prospective Register of Systematic Reviews (CRD42022384192) registered systematic review and meta-analysis was to determine whether prophylactic peritoneal dialysis (PD) catheter insertion at the time of pediatric cardiac surgery is associated with improved short-term outcomes.
    Data sources: Databases search of the MEDLINE, EMBASE, CINAHL, and Cochrane Library completed in April 2021 and updated October 2023.
    Study selection: Two reviewers independently completed study selection, data extraction, and bias assessment. Inclusion criteria were randomized controlled trials (RCTs) and observational studies of children (≤ 18 yr) undergoing cardiac surgery with cardiopulmonary bypass. We evaluated use of prophylactic PD catheter versus not.
    Data extraction: The primary outcome was in-hospital mortality, as well as secondary short-term outcomes. Pooled random-effect meta-analysis odds ratio with 95% CI are reported.
    Data synthesis: Seventeen studies met inclusion criteria, including four RCTs. The non-PD catheter group received supportive care that included diuretics and late placement of PD catheters in the ICU. Most study populations included children younger than 1 year and weight less than 10 kg. Cardiac surgery was most commonly used for arterial switch operation. In-hospital mortality was reported in 13 studies; pooled analysis showed no association between prophylactic PD catheter placement and in-hospital mortality. There were mixed results for ICU length of stay and time to negative fluid balance, with some studies showing shortened duration associated with use of prophylactic PD catheter insertion and others showing no difference. Overall, the studies had high risk for bias, mainly due to small sample size and lack of generalizability.
    Conclusions: In this meta-analysis, we have failed to demonstrate an association between prophylactic PD catheter insertion in children and infants undergoing cardiac surgery and reduced in-hospital mortality. Other relevant short-term outcomes, including markers of fluid overload, require further study.
    Language English
    Publishing date 2024-02-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2052349-X
    ISSN 1947-3893 ; 1529-7535
    ISSN (online) 1947-3893
    ISSN 1529-7535
    DOI 10.1097/PCC.0000000000003465
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  10. Article ; Online: Decision Makers Should Avoid the Health Years in Total (HYT) Approach: A Response to Dr Basu.

    Paulden, Mike / Sampson, Chris / O'Mahony, James F / Spackman, Eldon / McCabe, Christopher / Round, Jeff / Snowsill, Tristan

    Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

    2024  

    Language English
    Publishing date 2024-04-16
    Publishing country United States
    Document type Letter
    ZDB-ID 1471745-1
    ISSN 1524-4733 ; 1098-3015
    ISSN (online) 1524-4733
    ISSN 1098-3015
    DOI 10.1016/j.jval.2024.04.006
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