Improve Fast & Improve Cheap: Early Health Economic Analyses During Innovation Development

Abstract

Healthcare innovations are advancing rapidly, significantly improving the prevention, diagnosis, and treatment of diseases. However, this progress also drives rising healthcare costs, with hospital expenses in the Netherlands expected to be 2.5 times higher in 2060 than in 2025, reaching €100 million. Alongside financial pressures, healthcare systems face increasing staff shortages, which innovations may help alleviate. Healthcare innovations vary widely, from organizational changes and surgical techniques to e-health solutions. These can be either incremental improvements or radical, entirely new technologies. This thesis focuses on various healthcare innovations, excluding pharmaceuticals, whose research methods are already well-established. To ensure innovations add value to patient care and society, thorough evaluations are needed. These include technical (does the innovation work?), clinical (does it improve outcomes?), and economic assessments (are the costs justified by the benefits?). Economic evaluations typically compare alternatives using measures like Quality Adjusted Life Years (QALYs) and incremental cost-effectiveness ratios (ICERs). In the Netherlands, innovations are considered cost-effective if they fall within €20,000–€80,000 per QALY. Traditionally, economic analyses occur after clinical trials. However, performing these analyses early in development helps guide improvements and increases the likelihood of successful implementation. Early economic analyses are especially valuable because they can inform innovators and stakeholders throughout development. This thesis explores how to optimize these methods and maximize their impact. The first part of the thesis presents three case studies. The first, involving 616 brain surgery patients, assessed costs related to cerebrospinal fluid leaks. Reducing leak incidence by 75% could save up to €653,025 per 1,000 patients, highlighting areas for improvement. The second case study evaluated CARTBox, a tool to assist cardiologists during pacemaker and defibrillator implantations. Early economic analysis, conducted alongside clinical trial planning, showed CARTBox could reduce healthcare costs by €7,329 while improving outcomes by 0.17 QALYs—provided trial results meet expectations. The third case study analyzed a lifestyle intervention for psychiatric patients. Comparing healthcare costs before and after implementation showed no significant savings but revealed a shift in costs from hospital admissions to the intervention itself, prompting a larger follow-up study. The second part of the thesis explores the context and methodology of early economic analyses. A review of 364 studies published in 2022 found most were cost-utility analyses, though few focused on early-stage evaluations, likely because these are often kept internal. Interviews with 17 stakeholders confirmed the value of early analyses, emphasizing their role in informing rather than evaluating innovations. Stakeholders also suggested improvements, including better evidence, clearer innovation and reimbursement pathways, and "follow-the-money" analyses to track financial flows. This thesis concludes that early economic analyses are crucial tools for guiding healthcare innovation. By focusing on informing development, embracing iteration, and broadening evaluation criteria to include organizational and financial impact, these analyses can provide more actionable insights. Future research should focus on demonstrating the value of early analyses, enhancing efficiency, managing uncertainty over time, and adjusting requirements based on whether an innovation is incremental or radical.