Fernando Ignacio Sánchez Martínez

LOWERING THE ‘FLOOR’ OF THE SF‐6D SCORING ALGORITHM USING A LOTTERY EQUIVALENT METHOD

This paper presents a new scoring algorithm for the SF-6D, one of the most popular preference-based health status measures. Previous SF-6D value sets have a minimum (a floor), which is substantially higher than the lowest value generated by the EQ-5D model. Our algorithm expands the range of SF-6D utility scores in such a way that the floor is significantly lowered. We obtain the wider range because of the use of a lottery equivalent method through which preferences from a representative sample of Spanish general population are elicited.

La medición de la calidad de los estudios de evaluación económica: Una propuesta de "checklist" para la toma de decisiones

The aim of this paper is to promote the efficiency in the process of incorporating new health technologies, as well as to guide their implementation by physicians. An iterative method has been used to draw a checklist based on parsimony and measurability criteria. Authors made a first version of the checklist on the basis of theoretical literature and economic evaluation guidelines. This preliminary version was discussed and its validity was tested in two focus groups by doctors and managers of the regional public health systems of Murcia and Andalusia. As a result of this iterative process, we present a 12 criteria checklist in which a score is assigned to everyone of its items. The overall score a study receives (with a maximum of 100 points) is confronting to a set of cost per QALY thresholds, in order to assess if the technology been evaluated is cost-effective or not. The thresholds was selected from a previous study. We present a checklist and user guide which includes a cost per QALY thresholds matrix. This is an original proposal that has not been previously published in the Spanish literature. Our instrument needs some future improvements in terms of its validation and its spread to other types of cost-effectiveness analysis, apart from those that use QALYs. Nevertheless, our proposal may be useful to provide guidance on the usage and financing of new health technologies in Spain.

¿Cómo se deben establecer y evaluar las prioridades en salud y servicios de salud? Métodos de priorización y disparidades regionales. Informe SESPAS 2008

The conflict between scarce resources and unlimited needs is perhaps more prominent in the healthcare sector than in any other areas. Thus, setting priorities in health care emerges as an unavoidable task. The laudable aim of adopting any health technology that improves the populations health is impossible when confronted by budgetary constraints. Therefore, the outstanding health problems of a society and the most efficient health technologies in terms of their cost-effectiveness must be identified and patients must be prioritized, bearing in mind aspects of equity and efficiency. The present article reviews the issue of setting health care priorities by examining the experiences that have been put into practice in Spain and abroad. The problem is analyzed at three levels: the “macro” level (strategic planning, identification of higher priority areas and the selection of health care interventions); the “meso” level (incorporation of cost-effectiveness analyses into clinical practice guidelines), and the “micro” level (how to design priority systems for patients on waiting lists based on clinical and social criteria). In all these levels, there is substantial heterogeneity between Spanish regional health services, the steps that need to be taken and the ground that needs to be covered. Thus, we suggest that the first steps that some regional health services have made, together with international initiatives, could serve as a reference for the definitive incorporation of new approaches in priority setting in the Spanish health system as a whole.

Inverse probability weighted estimation of social tariffs: an illustration using the SF-6D value sets.

This paper presents a novel approach to model health state valuations using inverse probability weighting techniques. Our approach makes no assumption on the distribution of health state values, accommodates covariates in a flexible way, eschews parametric assumptions on the relationship between the outcome and the covariates, allows for an undetermined amount of heterogeneity in the estimates and it formally tests and corrects for sample selection biases. The proposed model is semi-parametrically estimated and it is illustrated with health state valuation data collected for Spain using the SF-6D descriptive system. Estimation results indicate that the standard regression model underestimates the utility loss that the Spanish general population assigns to departures from full health, particularly so for severe departures.

La valoración monetaria de los costes humanos de la siniestralidad vial en España

Cost-benefit analyses in the field of road safety compute human costs as a key component of total costs. The present article presents two studies promoted by the Directorate-General for Traffic aimed at obtaining official values for the costs associated with fatal and non-fatal traffic injuries in Spain. We combined the contingent valuation approach and the (modified) standard gamble technique in two surveys administered to large representative samples (n1=2,020, n2=2,000) of the Spanish population. The monetary value of preventing a fatality was estimated to be 1.4 million euros. Values of 219,000 and 6,100 euros were obtained for minor and severe non-fatal injuries, respectively. These figures are comparable to those observed in neighboring countries.

¿Cómo incorporar las utilidades de los pacientes a las decisiones clínicas? Informe SESPAS 2008

There are many clinical situations in which there is no “right” decision from a technical point of view. An example of this is elective surgery, in which patients’ preferences are critical. One way to integrate patients’ preferences within clinical practice is the application of decision analysis. According to this approach, preferences (utilities) are assessed and are then combined with physicians’ knowledge. This combination of evidence and utilities leads to the so-called shared decision-making (SDM) model. The overview provided in the present article indicates that: a) The SDM model, if systematically applied, could improve treatment effectiveness and patients well being; b) clinical practice, nevertheless, faces barriers in the form of time and resource constraints, limiting the application of such a model; c) discrepancies between patients’ and doctors’ preferences could be narrowed if patients’ utilities were included in clinical practice guidelines; d) the application of this kind of analysis seems to be scarce in Spain. Moreover, information provided to patients is probably insufficient; and e) patient decision aids, even though their use is rapidly growing, are subject to certain problems.There are many clinical situations in which there is no “right” decision from a technical point of view. An example of this is elective surgery, in which patients’ preferences are critical. One way to integrate patients’ preferences within clinical practice is the application of decision analysis. According to this approach, preferences (utilities) are assessed and are then combined with physicians’ knowledge. This combination of evidence and utilities leads to the so-called shared decision-making (SDM) model. The overview provided in the present article indicates that: a) The SDM model, if systematically applied, could improve treatment effectiveness and patients well being; b) clinical practice, nevertheless, faces barriers in the form of time and resource constraints, limiting the application of such a model; c) discrepancies between patients’ and doctors’ preferences could be narrowed if patients’ utilities were included in clinical practice guidelines; d) the application of this kind of analysis seems to be scarce in Spain. Moreover, information provided to patients is probably insufficient; and e) patient decision aids, even though their use is rapidly growing, are subject to certain problems.