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Policy Analysis of the Continuous Subcutaneous Insulin Infusion - Access With Evidence Development Scheme in Alberta: A Cost Effectiveness, Value of Information and SWOT Analysis

  • Author / Creator
    Lau, Robin S
  • Health systems aim to maximize patient access to health technologies on a fixed budget. Reimbursement decisions are increasingly complex and need to capture perspectives of multiple stakeholders. Decision makers must weight different types of evidence, much of which involves significant uncertainty. On May 30, 2013, Alberta Health announced the availability of continuous subcutaneous insulin infusion (CSII) for Alberta residents with type 1 diabetes mellitus (T1DM). At the time of announcement, evidence had shown that CSII is neither clearly inferior nor clearly superior to multiple daily injections (MDI) for the treatment of T1DM. Given the uncertainty surrounding CSII, an access with evidence development (AED) scheme was funded to gather the information needed to inform a definitive reimbursement decision. Using a continuous subcutaneous insulin infusion case study (CSII) compared with multiple daily injections (MDI), this thesis has three objectives: (1) to examine the role of cost effectiveness analysis (CEA) in reducing value for money uncertainties of CSII, (2) to explore the role of value of information analysis in decision making and whether or not delaying a decision to employ CSII and collecting more information will resolve decision uncertainty and (3) to examine the strengths and weaknesses of an access with evidence development scheme that addresses uncertainties surrounding government funded implementation of CSII in Alberta. CSII requires ongoing pump maintenance, the purchase of equipment and supplies, and incurs more ongoing cost that MDI. Although there are benefits to CSII, the cost is greater than the cost of MDI. Given the uncertainty surrounding CSII, it would be worthwhile to collect additional information on the quality adjusted life years associated with CSII and the effectiveness of CSII in reducing severe hypoglycemic events. The implementation of CSII under an AED scheme allows decision makers to (1) meet patient demand through managed entry, (2) improved patient safety and (3) control public funds. The use of AED schemes reflects pressures for increasing accountability, transparency, and timeliness of decision making. The trend toward conditional coverage suggest a growing need for conditional approval and integration of data collection into coverage and reimbursement schemes. Access with evidence development schemes have the potential to alter the reimbursement landscape for health technologies.

  • Subjects / Keywords
  • Graduation date
    Spring 2018
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R3N58D198
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.