Salta al menu principale di navigazione Salta al contenuto principale Salta al piè di pagina del sito

Saggi

N. 131 (2024)

Putting a financial accounting and a health economic perspective face to face to inform public health management decision-making

DOI
https://doi.org/10.3280/mesa2024-131oa20242
Inviata
maggio 23, 2025
Pubblicato
2025-07-03

Abstract

Evidence-based decision-making serves as a fundamental principle in public health management, particularly in resource allocation. Various economic frameworks have been devised to support these decisions, each grounded in distinct philosophies and objective functions. Nonetheless, public health managers increasingly face the complex task of balancing the needs and perspectives of diverse stakeholders, often leading to conflicting interests, significantly hindering optimal managerial decision-making and policy implementation. Indeed, depending on what benefits are considered and their relative value, choice of intervention may change. However, to date no empirical study has analytically examined this issue. This paper addresses this gap by applying a break-even analysis approach and utilizing a real-world case study in stroke treatment. We illustrate how patient volume requirements can vary significantly based on whether a financial accounting or a health economic perspective on the benefits of the intervention is adopted.

Riferimenti bibliografici

  1. Shillabeer A., Buss T. F., & Rousseau D. M. (2011). Evidence-Based Public Management: Practices, Issues and Prospects (1st ed.).
  2. Institute for Government (2015). Evidence Transparency Framework Report. -- [Retrieved from https://www.instituteforgovernment.org.uk/publication/report/evidence-transparency-framework, accessed 05.02.2024].
  3. National Institute of Corrections (2017). Evidence-Based Practices in the Criminal Justice System: Annotated Bibliography. -- [Retrieved
  4. from https://nicic.gov/resources/nic-library/all-library-items/evidence-based-practices-criminal-justice-system-annotated, accessed 05.02.2024].
  5. European Commission (2021). EU4Health Programme 2021-2027: A Vision for a Healthier European Union. -- [Retrieved from https://health.ec.europa.eu/funding/eu4health-programme-2021-2027-vision-healthier-european-union_en, accessed 05.02.2024].
  6. World Health Organization (2022). Evidence, policy, impact: WHO guide for evidence-informed decision-making. -- [Retrieved from https://www.who.int/publications/i/item/9789240039872, accessed 05.02.2024].
  7. Borgonovi E. (2005). Principi e sistemi aziendali per le amministrazioni pubbliche. (5th ed.). Milano: Egea.
  8. Torbica A., & Fattore G. (2005). The “Essential Levels of Care” in Italy: when being explicit serves the devolution of powers. European Journal of Health Economics, 6(Suppl 1): 46-52. DOI: 10.1007/s10198-005-0318-x.
  9. Barnieh L., Manns B., Harris A., Blom M., Donaldson C., Klarenbach S., Husereau D., Lorenzetti D., & Clement F. (2014). A Synthesis of Drug Reimbursement Decision-Making Processes in Organisation for Economic Co-operation and Development Countries. Value in Health, 17(1): 98-108. DOI: 10.1016/j.jval.2013.10.008.
  10. Suchmacher M., & Geller M. (2021). Chapter 5 – Pharmacoeconomics. In M. Suchmacher M. & Geller M. (Eds.). Practical Biostatistics (Second Edition) (pp. 29-44). Academic Press. DOI: 10.1016/B978-0-323-90102-4.00019-9.
  11. Richardson J., & Schlander M. (2018). Health technology assessment (HTA) and economic evaluation: efficiency or fairness first. Journal of Market Access & Health Policy, 7(1), 1557981. DOI: 10.1080/20016689.2018.1557981.
  12. Hoomans T., & Severens J. L. (2014). Economic evaluation of implementation strategies in health care. Implementation Science, 9, 168. DOI: 10.1186/s13012-014-0168-y.
  13. Prieto L., & Sacristán J. A. (2003). Problems and solutions in calculating quality-adjusted life years (QALYs). Health and Quality of Life Outcomes, 1, 80. DOI: 10.1186/1477-7525-1-80.
  14. Lohmann R. A. (1976). Break-even analysis: tool for budget planning. Social Work, 21(4): 300-307. Oxford University Press.
  15. Figueroa C. A., Harrison R., Chauhan A., & Meyer L. (2019). Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Services Research, 19(1), 239. DOI: 10.1186/s12913-019-4080-7.
  16. European Commission (2023). Decision C (2023) 2178 of 31 March 2023. Horizon Europe Work Programme 2023-2024. -- Retrieved from https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/wp-call/2023-2024/wp-4-health_horizon-2023-2024_en.pdf.
  17. Ganesalingam J., Pizzo E., Morris S., Sunderland T., Ames D., & Lobotesis K. (2015). Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke. Stroke, 46(9): 2591-2598. DOI: 10.1161/STROKEAHA.115.009396.
  18. Pan Y., Cai X., Huo X. et al. (2018). Cost-effectiveness of mechanical thrombectomy within 6 hours of acute ischaemic stroke in China. BMJ Open, 8, e018951. DOI: 10.1136/bmjopen-2017-018951.
  19. Kaboré N., Marnat G., Rouanet F., Barreau X., Verpillot E., Menegon P., Maachi I., Berge J., Sibon I., & Bénard A. (2019). Cost-effectiveness analysis of mechanical thrombectomy plus tissue-type plasminogen activator compared with tissue-type plasminogen activator alone for acute ischemic stroke in France. Revue Neurologique, 175(4): 252-260. DOI: 10.1016/j.neurol.2018.06.007.
  20. Ruggeri M., Basile M., Zini A., Mangiafico S., Agostoni E. C., Lobotesis K., Saver J., Coretti S., Drago C., & Cicchetti A. (2018). Cost-effectiveness analysis of mechanical thrombectomy with stent retriever in the treatment of acute ischemic stroke in Italy. Journal of Medical Economics, 21(9): 902-911. DOI: 10.1080/13696998.2018.1484748.
  21. Kim A. S., Nguyen-Huynh M., & Johnston S. C. (2011). A cost-utility analysis of mechanical thrombectomy as an adjunct to intravenous tissue-type plasminogen activator for acute large-vessel ischemic stroke. Stroke, 42(7): 2013-2018. DOI: 10.1161/STROKEAHA.110.606889.
  22. Candio P., Violato M., Leal J., & Luengo-Fernandez R. (2021). Cost-Effectiveness of Mechanical Thrombectomy for Treatment of Nonminor Ischemic Stroke Across Europe. Stroke, 52(2): 664-673. DOI: 10.1161/STROKEAHA.120.031027.
  23. Goyal M., Menon B. K., van Zwam W. H. et al. (2016). Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet, 387(10029): 1723-1731.
  24. NHS England (2020). Understanding and using the national tariff November 2020 NHS. [Online]. -- Available at: https://www.england.nhs.uk/wp-content/uploads/2021/02/20-21NT_Understanding_and_using_the_national_tariff.pdf [Accessed 13th February 2024].
  25. McCabe C., Claxton K., & Culyer A. J. (2008). The NICE cost-effectiveness threshold: what it is and what that means. Pharmacoeconomics, 26(9): 733-744. DOI: 10.2165/00019053-200826090-00004.
  26. National Institute for Health and Care Excellence (2013). How NICE measures value for money in relation to public health interventions: Local government briefing. [Online]. -- Available at: https://www.nice.org.uk/guidance/lgb10. [Accessed 13th February 2024].
  27. Frazão T., Camilo D., Cabral E. et al. (2018). Multicriteria decision analysis (MCDA) in health care: a systematic review of the main characteristics and methodological steps. BMC Medical Informatics and Decision Making, 18, 90. DOI: 10.1186/s12911-018-0663-1.
  28. Oliveira M. D., Mataloto I., & Kanavos P. (2019). Multi-criteria decision analysis for health technology assessment: addressing methodological challenges to improve the state of the art. European Journal of Health Economics, 20: 891-918. DOI: 10.1007/s10198-019-01052-3.
  29. Bates S. E., Thomas C., Islam N., Ahern A. L., Breeze P., Griffin S., & Brennan A. (2022). Using health economic modelling to inform the design and development of an intervention: estimating the justifiable cost of weight loss maintenance in the UK. BMC Public Health, 22(1), 290. DOI: 10.1186/s12889-022-12737-5.
  30. Candio P., & Frew E. (2023). How much behaviour change is required for the investment in cycling infrastructure to be sustainable? A breakeven analysis. PLOS ONE, 18(4), e0284634. DOI: 10.1371/journal.pone.0284634.
  31. Rohwer A., Toews I., Uwimana-Nicol J. et al. (2023). Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review. BMC Health Services Research, 23(1), 894. DOI: 10.1186/s12913-023-09894-7.
  32. Shah K. K., Cookson R., Culyer A. J., & Littlejohns P. (2013). NICE’s social value judgments about equity in health and health care. Health Economics, Policy, and Law, 8(2): 145-165. DOI: 10.1017/S1744133112000096.
  33. Round J., & Paulden M. (2018). Incorporating equity in economic evaluations: a multi-attribute equity state approach. The European Journal of Health Economics, 19(4): 489-498. -- http://www.jstor.org/stable/45156376.
  34. Hovenga E. (2022). Guideline and knowledge management in a digital world. In: E. Hovenga & H. Grain (Eds.). Roadmap to successful digital health ecosystems (pp. 239-270). Academic Press. DOI: 10.1016/B978-0-12-823413-6.00012-4.

Metriche

Caricamento metriche ...