What is the value of explicit priority setting for health interventions? A simulation study

In the modern era, medical advancements hold unprecedented promise in reducing human suffering and extending lifespans. Nevertheless, in a global context marked by finite resources, the allocation of funds for health purposes demands careful and often difficult decisions. Many countries have responded to this challenge through the establishment of Priority Setting Institutions (PSIs) in healthcare systems. This is a relatively novel approach that aims to make transparent and accountable decisions about resource and funding allocation in healthcare.

A study named: ‘What is the value of explicit priority setting for health interventions’ by Barlow et al., suggests that using PSIs are beneficial for making healthcare funding decisions and can be useful for policymakers when establishing or evaluating interventions. Although several studies examined the role of priority-setting institutions, most studies lack the consideration of a PSI-absent scenario which may offer a new perspective on the value of a PSI. It also mentions that while the results suggest that PSIs provide significant value, the exact magnitude of their impact depends on a range of factors and modeling assumptions.

To understand the value of a PSI, this study examines its value in healthcare spending by comparing two funding approaches. The first, an active PSI using cost-effectiveness thresholds to influence funding decisions and the second approach being one without a PSI, where funding decisions on interventions are made on a first-come-first-served basis. The text outlines a simulation study that discusses the value of explicit priority setting and the role of priority setting agencies in different countries. One approach includes modeling studies that use economic models to evaluate the health and financial impact of interventions. The other approach uses implementation studies that examine changes in clinical practice following PSI recommendations.

A user-friendly simulation model on Microsoft Excel, which can be adapted to local contexts, was developed as part of this study. From this simulation study, some key findings were shown to assess the value of explicit priority setting for health intervention:

1.      Explicit priority setting can lead to more efficient resource allocation.

2.      A PSI-active funding scenario reveals that it can lead to better health outcomes and benefits for the population, achieve a lower incremental cost-effectiveness ratio (ICER), and can fund more interventions when compared to a PSI-absent funding scenario.

3.      PSIs foster transparency when taking a formal evaluation approach where it lessens the scope for corruption in decision-making.

This study also examines different circumstances with varying levels of PSI involvement, budget limitations, and results. Data from the UK (2015) and Malawi (2018) shows that the threshold-based approach improves health outcomes while decreasing healthcare costs. In addition, sensitivity analyses in the study explore the impact of cost-effectiveness thresholds, budget constraints and the correlation between costs and benefits in interventions.

This study also highlights the underutilization of simulation methods in assessing the economic and health impact of institutionalizing priority setting. By taking this important initial step, the aim is to demonstrate the value of such approaches and encourage governments, especially in low- and middle-income countries (LMICs), to invest in PSIs. Furthermore, it promotes the use of simulation methods to understand policy-related questions to contribute to healthcare outcomes in the future. Lastly, the findings from this study align with current literature and indicate there is substantial positive impact from PSIs in both resource-constrained and resource-rich contexts.

If you are interested in using this tool and exploring the simulations, please find the user-friendly spreadsheet tool here. To read more about the article, please click on this link: https://link.springer.com/article/10.1007/s10729-022-09594-4