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Biomedical subjects

T Walley

Publications and source records attributed to T Walley.

At least 73 records · Page 4Linked to original sources
PubMed1997

Economic evaluations of drug therapy: attitudes of primary care prescribing advisers in Great Britain.

All health authorities in Great Britain have both medically or pharmaceutical qualified staff to advise both the authority and the local primary care medical practitioners about drug use and prescribing. This study used a piloted postal questionnaire to assess the attitudes of these advisers to economic evaluations of drug therapy, and their perceptions of the barriers to achieving cost effective prescribing by use of these evaluations. There was a 65% response rate to the questionnaire. Economic issues were rated by advisers to be less important than clinical issues, but were considered at most meetings between advisers and primary care medical practitioners. Advisers wished to consider true cost effective prescribing but often felt obliged to consider drug acquisition costs and risks of budgetary overspends. The perceived inflexibility of existing structures within the British National Health Service and the lack of credibility of the evaluations (often perceived as pharmaceutical industry marketing) were the major barriers to the application of the evaluations. The paper concludes that advisers were keen to use economic evaluations to promote cost effective prescribing but were impeded by the perceived bias of existing studies and by rigid current NHS structures.

Attitude of Health Personnel↗
PubMed1997

General practice fundholders' prescribing savings in one region of the United Kingdom, 1991-1994.

Since 1991, fundholding general practitioners in the UK have had a financial incentive to contain prescribing costs. Research has confirmed that fundholding practices have contained their prescribing costs more effectively than non-fundholding practices, but how much fundholders have actually saved by changing their prescribing is difficult to quantify. Fundholders are allocated a prescribing budget, and the underspend on this budget has been taken to represent savings produced by changing prescribing behaviour. However, this assumes accuracy of budget setting, which has been questioned. The objective of this study was to estimate the true savings in prescribing made by fundholders during the first 3 years of fundholding, without making assumptions about the accuracy of budget setting. We compare this to underspends on prescribing budgets. The results suggest that budget setting did not give fundholders over-generous budgets and that budget underspends are justified by the true savings in prescribing.

Budgets↗
PubMed1997

Economic evaluation under managed competition: evidence from the U.K.

Although economic evaluation in health care has a long-standing tradition in the United Kingdom, very little is known about its impact on decision making, particularly following the introduction of the internal market. Since managed competition appears to be growing in popularity worldwide, the U.K. is an interesting case study, as the reforms are well underway and there have been a number of efforts to conduct and disseminate economic evaluations. In this paper the potential for using economic evaluation in health care decision making in the U.K. is discussed. Then its actual impact is assessed in two ways. First, two case studies are discussed, on heart transplantation and the use of pharmaceuticals in the management of labour in pregnancy. Second, new data from a recent survey of potential users of economic evaluations are presented, with the emphasis on exploring the reasons for the impact, or lack of impact, of economic results. It is concluded that the NHS reforms increase the potential for the use of economic evaluation. However, there is a need to increase decision makers' awareness of economic studies and to help them interpret study methodology and results. Although worries about validity of economic studies are one of the major barriers to their use, other important barriers relate to the multiple objectives being pursued, of which increased efficiency is just one, and the difficulties of freeing resources from existing services in order to divert them to more cost-effective treatments and programmes.

Cost-Benefit Analysis↗
PubMed1997

Drug rationing in the UK National Health Service. Current status and future prospects.

There are major problems in attempting to ration drug use in the UK. These include the large indigenous pharmaceutical industry, the nature of funding of drugs within the National Health Service (NHS) and the political sensitivities of rationing. Rationing of services within the NHS has therefore usually been implicit rather than explicit, and there is little public debate about rationing of health services. In relation to drug therapy, prescribing in primary care technically can only be rationed by encouraging the general practitioner (GP) to contain his or her own costs-effectively moving the difficult decision to the GP. Direct incentives to the GP, in the form of incentive payments or by fundholding seem to have some success in containing costs, largely by simple generic substitution. There are established systems in hospitals to control the costs of drugs, including formularies and drug management committees. Hospitals commonly try to transfer drug costs to the GP budget. While in part this is clinically appropriate, it can lead to tensions. Health authorities and GP fundholders now include prescribing, particularly at this interface, in their contracts with hospitals. Economic evaluations currently play little part in aiding decisions about choice of drug. These decisions tend to be dominated by the need for short term cost containment in the UK. Recent reforms of the NHS have moved responsibility for the rationing of services to the local authorities or purchasers; this might in time create an additional, local hurdle for pharmaceutical companies trying to market new drugs. A proposal to introduce a national limited formulary in which drugs will be selected partly on the basis of an economic evaluation seems impractical, although similar ideas might be further developed.

Health Care Rationing↗
PubMed1996

Influences of practice characteristics on prescribing in fundholding and non-fundholding general practices: an observational study.

OBJECTIVE: To investigate the variation in prescribing among general practices by examining the contribution to this variation of fundholding, training status, partnership status, and the level of deprivation in the practice population and to investigate the extent to which fundholding has been responsible for any changes in prescribing. DESIGN: Analysis of prescribing data (PACT) for the years 1990-1 (before fundholding) and 1993-4 (after fundholding), Use of multiple linear regressions to investigate the variation among practices in total prescribing costs (net ingredient cost per prescribing units), and mean cost per item in each of the two years and also the change in these variables between years. SETTING: Former Mersey region. SUBJECTS: 384 practices. RESULTS: The models developed explained the variation in cost per item (43% of variation explained for 1990-1, 38% for 1993-4) and prescribing volume (34% for 1990-1, 38% for 1993-4) better than the variation in total prescribing costs (3% for 1990-1, 7% for 1993-4). The models developed to explain the change in these variables between years did not explain more than 10% of the variation. Most of the explained variation in the change in total prescribing costs was accounted for by fundholding. Of the pounds 3.71 saved by first wave fundholders compared with non-fundholders pounds 3.57 was attributable to fundholding alone. CONCLUSION: In neither year did fundholding make a major contribution to the variation in prescribing behaviour among practices, which was better explained by deprivation, training status, and partnership status, but it did seem largely responsible for differences in the rise of total prescribing costs between fundholders and non fundholders.

Drug Prescriptions↗