Priorities 2016 summary
By Paul Mark Mitchell, Health Economist at the University Of Bristol
This was my first experience of the biennial conference organised by the International Society on Priorities in Health Care. The society was founded in 1996 at the University of Birmingham in the UK and returned to its spiritual home 20 years on. As well as bringing bioethicists, philosophers, economists, health care practitioners and patient advocates together, the conference also saw the combined wits of the Health Service Management Centre (HSMC) and the Health Economics Unit (HEU), co-chaired by Iestyn Williams and Joanna Coast (now at Bristol), who organised a very insightful programme that stimulated plenty of debate between attendants.
After a recent bad experience of plenary talks, PRIORITIES 2016 managed to return my faith in the power of good plenary sessions. The opening session of the conference by Angela Coulter, Rachel Baker and Sally Brearley, focusing on the application and practicalities of incorporating patient views into healthcare decision-making, set the tone for high quality presentations over the three days. Although impossible to summarise all the relevant contributions made with simultaneous sessions throughout, I will focus on my highlights.
Multi-criteria decision analysis (MCDA) is something that has been gaining a lot of attention in health economics, so I jumped at the chance to learn more from some of the key names involved in its use and development. I was slightly surprised then to hear Rob Balthussen make a convincing argument why going beyond the quantification of more than two criteria is likely to muddle more than help decision-making. Instead, he made an argument for a deliberate form of MCDA when presenting decision makers with more than two criteria, sounding somewhat similar to a cost consequence analysis in health economics. This deliberative form of MCDA was also argued to align more closely with Norman Daniels accountability for reasonableness priority setting ethical framework.
There were numerous relevant health economics talks of interest. In terms of commissioning health services in England, there was an organised session led by Hugh McLeod on a new project starting in Gloucestershire Central Commissioning Group (CCG), who are planning to trial the use of the ICECAP capability measure to aid their decision-making. At the same time of this talk, there was also a Health Foundation sponsored session on how to set priorities across the NHS, with speakers including Cam Donaldson and Muir Gray. By many accounts, it was the highlight of the conference for those who attended.
Other notable health economics sessions looked at how benefits are measured, with Lidia Engel presenting twice from her PhD research, including a helpful conceptual map of the multiple options available when considering how going beyond the quality adjusted life year (QALY) could be operationalised in practice. Yvonne Michel looked at issues in asking patients with spinal cord injury about their mobility in terms of walking, a common feature in health measures used in the generation of QALYs. My talk on how capabilities could be an appropriate evaluative space in renal care also took place in this lively session.
Another session with an economic evaluation focus included a talk by Hareth Al-Janabi on his research looking at incorporating health spillover effects on the family from children with health conditions, with his example drawing from data on children with meningitis in the UK. Lars Schwettmann discussed inconsistencies in the willingness to pay for QALYs in the German sample of the EURO VAQ project. Joseph Millum discussed his attempts to place different values on the disutility of death at different ages of childhood, prompting the largest proportion of hands raised by those in attendance following a presentation that I have seen. There was also a talk from three US based researchers who presented a systematic review for looking at how social justice could be incorporated into an economic evaluation. This session was chaired by Stirling Bryan, who had previously discussed his recently published paper in Medical Decision Making with Graham Scotland at the conference, on the search for efficiency in current health care provision versus the current focus of the majority of most health economic analysis on new interventions.
It was also a good conference in terms of getting international perspectives on how health economics is used to aid priority setting in different countries. Key debates included the use of health/QALY maximisation alone, versus how it is combined with equity concerns around absolute shortfall as implemented in Norway, presented by Trygve Ottersen and proportional shortfall as implemented in the Netherlands, presented by Werner Brouwer. Another interesting development is the use of income as an equity consideration to be incorporated alongside the health outcome in economic analysis, with Ole Norheim and Richard Cookson working on this new area of research.
The above is only a microcosm of the PRIORITIES 2016 conference through the perspective of one attendant. I would highly recommend keeping your eyes peeled for when this conference comes around again in 2018. It may not have had health economics in the title, but I would highly recommend health economists to attend and share their experience with others in related areas of research and practice at this very worthwhile meeting.