- Title
- Evidence and value based healthcare decision making for chronic disease in China
- Creator
- Hu, Hao
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2017
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Different with the western developed countries, the current healthcare reimbursement system in China is not to maximize cost-effectiveness, but rather to provide basic drug coverage and to contain costs. As a consequence, the current system provides limited coverage for drugs under patent, even when these drugs are clinically more effective than cheaper alternatives already reimbursed. With the rapid economy developments in the past three decades, the Chinese government has the intention to include more innovative drugs in healthcare reimbursement coverage to satisfy public healthcare needs. In order to implement this effectively, China is moving towards evidence and value-based healthcare decision making. Among various techniques of health economics evaluations, the cost-utility analysis with quality adjusted life years derived from preference based generic health related quality of life instruments was particularly endorsed by the Chinese health economics guidelines. However, when conducting these kinds of analyses, one of the most obvious barriers for researchers and decision makers is the availability of evidence; typically either cost or utility data were unavailable from existing studies. A fundamental question could be easily asked: how to implement the evidence and value based healthcare decision making in China in the context of lack of health economics evidences? In this thesis we attempted to answer this question systematically, taking rheumatoid arthritis as the example indication. First, for utility and quality of life, we conducted a systematic review on the use of quality of life instruments in published studies, having identified the gap in quality of life research in China and the need to validate the quality of life instruments in Chinese settings. Based on this finding, we validated the most commonly used but not yet validated HRQL instruments and investigated the quality of life of Chinese patients from physical and mental perspectives respectively. In these studies, the validated instruments demonstrated good acceptability and psychometric properties in Chinese patients, which would provide the basis to justify the use of these instruments in not only future quality of life research in China, but also provide evidence to support the results of the historical ones. Then through modelling, we built up the mapping relationship between the most commonly used disease specific instruments and the most commonly used generic one, which would be important for deriving utility values in the case of unavailability of evidence with generic instruments. Second, to quantify the costs of chronic disease management, the economic burden of rheumatoid arthritis in China was researched through a cost of illness cross sectional study. In this study, besides the substantial burden in terms of direct medical cost and productivity lost, notable intangible costs were observed, especially among the older patients. Third, to verify whether these findings can be applied in other countries, the transferability of direct cost of chronic disease across different countries was then further researched. Using the approach by converting the raw cost data into percentage of GDP/capita of individual country, our results showed that it would be feasible to transfer the direct medical cost across countries. Hence, the approach could be potentially useful for a quick check on the economic burden of particular disease for countries without the information, using cost data from other jurisdiction. This would contribute to facilitate informed decision making in health care resource allocation. In conclusion, this thesis has systematically contributed new knowledge to the feasibility of technical implementing economic evaluations for chronic disease using rheumatoid arthritis as an illustrative example in China. With the validated HRQL instruments, the new mapping algorithm to derive utility values, the real world cost of illness and the approach to facilitate cost transferability from the studies of this thesis, we would arrive at a conclusion that researchers can embrace a more rational evidence and value based healthcare decision making process for managing RA in China. Furthermore, this information would not only be useful for clinicians and healthcare administrators in China, but other countries with similar stage of economic development. In addition, we would state that the same approach can be applied in a similar manner to study other chronic diseases in China and other developing countries.
- Subject
- Chinese; patient-reported outcome; quality of life; rheumatoid arthritis; health assessment questionnaire
- Identifier
- http://hdl.handle.net/1959.13/1349948
- Identifier
- uon:30462
- Rights
- Copyright 2017 Hao Hu
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 747 KB | Adobe Acrobat PDF | View Details Download |