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HEADROOM BEYOND THE QUALITY- ADJUSTED LIFE-YEAR: THE CASE OF COMPLEX PEDIATRIC NEUROLOGY

Part of: Special Collection - Methods

Published online by Cambridge University Press:  30 May 2017

Kirsten J.M. van Nimwegen ,
Richard J. Lilford ,
Gert J. van der Wilt  and
Janneke P.C. Grutters
Kirsten J.M. van Nimwegen
Affiliation:
Radboud University Medical Center, Department for Health Evidence, Radboud Institute for Health Scienceskvannimwegen@pharmerit.com
Richard J. Lilford
Affiliation:
University of Warwick, Centre for Applied Health Research and Delivery, University of Warwick
Gert J. van der Wilt
Affiliation:
Radboud University Medical Center, Department for Health Evidence, Donders Centre for Neuroscience
Janneke P.C. Grutters
Affiliation:
Radboud University Medical Center, Department for Health Evidence, Radboud Institute for Health Sciences
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Abstract

Objectives: The headroom method was introduced for the very early evaluation of the potential value of new technologies. It allows for establishing a ceiling price for technologies to still be cost-effective by combining the maximum effect a technology might yield, the maximum willingness-to-pay (WTP) for this effect, and potential downstream expenses and savings. Although the headroom method is QALY-based, not all innovations are expected to result in QALY gain.

Methods: This study explores the feasibility and usefulness of the headroom method in the evaluation of technologies that are unlikely to result in QALY gain. This will be illustrated with the diagnostic trajectory of complex pediatric neurology (CPN).

Results: Our headroom analysis showed a large room for improvement in the current diagnostic trajectory of CPN in terms of diagnostic yield. Combining this with a maximum WTP value for an additional diagnosis and the potential downstream expenses and savings, resulted in a total headroom of €15,028. This indicates that a new technology in this particular diagnostic trajectory, might be cost-effective as long as its costs do not exceed €15,028.

Conclusions: The headroom method seems a useful tool in the very early evaluation of medical technologies, also in cases when immediate QALY gain is unlikely. It allows for allocating healthcare resources to those technologies that are most promising. It should be kept in mind, however, that the headroom assumes an optimistic scenario, and for that reason cannot guarantee future cost-effectiveness. It might be most useful for ruling out those technologies that are unlikely to be cost-effective.

Keywords

Headroom analysisHealth economic evaluationDiagnostic technologiesHealth technology assessment
Type
Methods
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 1 , 2017 , pp. 5 - 10
Copyright
Copyright © Cambridge University Press 2017 

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