Professor Elizabeth Geelhoed is Health Economist within the School of Population Health at The University of Western Australia and has worked across education, research and policy development for the past 25 years. Previous positions include as Senior Policy Officer (Health Economics) in the Department of Health, WA and as a research health economist in the hospital setting. Prof Geelhoed is a founding member of the development team for Health Economic units within the Peoples Open Access Education Initiative (Peoples-uni) which was established to build public health capacity in low to middle income countries via e-learning.
Dr Geelhoed is currently a chief investigator on twelve successful state or nationally competitive grants, in each case providing the health economic input which contributes to the assessment of feasibility of the project and hence the translation into practice. Over the past 5 years, research funds have exceeded $11million and have resulted in some 42 publications. National consultation is fostered through committee roles such as member of the MSAC Evaluation subcommittee (evaluating new medical technologies and procedures within the process of listing for Medicare subsidy), contribution to NHMRC research panels and a number of interstate research collaborations.
Achieving high value for patients is the overarching goal of health care delivery, which unites the interests of all actors in the system. If value improves, patients, payers, providers, and suppliers can all benefit within an economically sustainability health system.
Value based health care requires an appreciation of both outcomes and resource inputs in order to monitor and enhance quality within a constrained budget.
As a measure of value, cost-effectiveness has been an important mainstay for introduction of government-subsidised pharmaceuticals for more than 30 years in Australia and has led the application of economic evaluation globally within this domain. More recently, a ‘value-based’ approach suggests that cost-effectiveness has limitations in terms of the information it provides to decision makers. Traditionally, outcomes have been limited to cost per quality adjusted life year (QALY) or cost per life year gained (LYG) and objectives such as distributional issues have formed part of the decisional judgement. However developing methodologies seek to incorporate multiple criteria in terms of patient-centred outcomes and to address multiple objectives, such as inclusion of equity. Evidence-based policy increasingly requires information to assess value in addition to quality and ongoing evaluation requires appropriate surveillance systems to collect and analyse relevant data.
While pharmaceutical interventions represent a relatively straightforward application, other applications such community pharmacies are more difficult to evaluate but can nevertheless be considered within the same paradigm, particularly when addressing components of care such as the use of drug plans and models of care.
What data and tools are most relevant for pharmacists working in the health system and how can application contribute to optimal value-based health care?