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The constant innovations in healthcare generate new costs for the sector and, therefore, every new technology to be incorporated goes through the meticulous process of Healthcare Technology Assessments (HTA), which serve as a basis for decision-making. One of HTA’s main tools to ensure that the costs of a new technology can be absorbed is budget impact analysis (AIO). Learn more about this critical tool for economic healthcare assessments.
What is the budget impact analysis of economic evaluations in healthcare?
In short, budget impact analysis (AIO) is a tool used in economic evaluations in health that allows the manager to assess the financial consequences of incorporating a given technology in the evaluated scenario. Unlike a cost-effectiveness analysis, however, it does not compare the impacts of two different technologies, but rather the costs of adopting a technology versus the scenario without incorporation. The ultimate goal, therefore, is to assess the incremental cost of the novelty, helping the manager to make the budget forecast. For this, an AIO must take into account:
Assumptions of an AIO/h2>- Description of the health problem that motivated the search for the incorporation of the new technology;
- Description of the technology itself;
- Perspective (point of view) of the analysis;
- Horizon season analysis;
- Criteria for access to technology and justification for restrictions, if any;
- Direct and associated costs of the analyzed technology.
For an AIO to be well-founded, it is essential that, before starting the assessment, some assumptions are defined, such as:
Methods used in budget impact analysis (AIO)
The final result of an AIO basically depends on two pieces of information: the cost of treatment and the incremental budgetary impact. The cost of a treatment can be calculated by multiplying the number of people who must be treated by the cost of the studied therapy. The incremental budget impact is nothing more than the cost difference between the scenarios projected with the new technology and the current one. According to the methodological guidelines of the Ministry of Health, there are fundamentally two types of models to unite these two pieces of information:
Static models
This type of model can use a deterministic spreadsheet or a simple decision tree as a tool. It consists of multiplying the individual cost of the technology by the target population, in the case of chronic diseases, or episodes with indication for treatment, for acute ones. It is the simplest and most widespread method, but it has some limitations, such as the difficulty of using it for diseases with frequent crises and remissions.
Dynamic models
Like the recognized Markov model, dynamic methods depend on the development of a model of transitional states, with the objective of simulating the disease and its different possibilities of transition between health states, as well as the possible changes between different therapeutic options over time.
Target population
The target population is a fundamental factor in the AIO stage of economic assessments in healthcare and its delimitation can be done in two ways: by the epidemiological method, in which the population is defined by calculations made based on the most recent official data available; and by the measured demand method, used when the manager already has an estimate of the population of interest. This last approach is known as the claims data-based model (Canadian guidelines) or the market share approach (Australian guidelines).It can be performed by counting registered patients, when there is a registration system, or by using historical data.
It is noteworthy that the definitions about the population, as well as the costs, are factors that are extremely dependent on the perspective of the analysis, since the scenario in the Unified Health System (SUS) or in the supplementary healthcare system, for example, are quite different. Thus, the information used in the AIOs of economic health assessments should always take into account the point of view that was established at the beginning of the analysis.
To learn more about economic assessments in healthcare, HTA and technology incorporation, download the MAPES e-book: MAPES:Cases&Solutions..[:]
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