Performing or not performing: what's in a target?

This paper analyses how providers have coped with the 4-hour target over the past 7 years. To do this, we used publicly available data from NHS Digital to track how long patients remain in accident and emergency (A&E) departments and their 'attendance disposal method'. Using this tool, we compared two A&E departments with similar arrival patterns and age profiles and that perform equally well against the target in a specific year. However, these hospitals exhibit very different underlying behaviour. Over 7 years, both exhibit a general increase in length of stay, increasing number of patients being admitted in the 20 minutes preceding the 4-hour target, and rising numbers of patients that breach the target. Despite the two hospitals having similar input profiles there is a 12 percentage point difference in the number of patients who leave the A&E department in the last 20 minutes. This operational information is not visible simply by monitoring the single existing metric. We conclude that the 4-hour target in isolation is an inadequate measure and we reflect on the difference between selecting measures for policy-level review, and for operational management. A link to download the graphs for each A&E in England is available.

Pricing of medical devices under coverage uncertainty--a modelling approach.

Product vendors and manufacturers are increasingly aware that purchasers of health care will fund new clinical treatments only if they are perceived to deliver value-for-money. This influences companies' internal commercial decisions, including the price they set for their products. Other things being equal, there is a price threshold, which is the maximum price at which the device will be funded and which, if its value were known, would play a central role in price determination. This paper examines the problem of pricing a medical device from the vendor's point of view in the presence of uncertainty about what the price threshold will be. A formal solution is obtained by maximising the expected value of the net revenue function, assuming a Bayesian prior distribution for the price threshold. A least admissible price is identified. The model can also be used as a tool for analysing proposed pricing policies when no formal prior specification of uncertainty is available.

Ultrasonic imaging technologies in perspective.

Ultrasonic imaging is a mature and widely used medical diagnostic technology but it is also a field of intense research activity. Innovations are viewed with differing perspectives by the stakeholders- users, industrialists, regulators, and researchers and research funders. The more important recent developments include advances in transducers, scanning schemes, coded excitation, three-dimensional, high-resolution and high-speed imaging, contrast agents, harmonic, elasticity and strain imaging, point-of-care devices, computed tomography, thermoacoustic, photoacoustic, acousto-optic and Hall effect imaging. Viewed from diverse perspectives, the assessment of ultrasonic imaging technologies is intellectually challenging. This is a general problem, which demands a multidisciplinary approach. An emerging, integrated, context for such assessment is presented. Given the straitened economies around the world, the need to articulate value for each and all stakeholders is becoming increasingly important.

Price trend analysis and its implications for the development of new medical technologies.

It is assumed that a company will only develop a new medical technology if it has evidence that it will provide returns that are greater than the investment required to develop that technology and bring it to the market. The price that can be commanded for the new products and the volumes of the products that are sold determine, in large measure, the returns that will be made on the initial investment. Estimating the sales volumes and prices of products are critical factors in decision making during product development. Once in the market prices are not static. Rather they are affected by a range of factors. This paper considers the effect that market experience, represented by cumulative volume of sales, has on prices. How quickly the price declines in response to experience is dependent on a number of factors. How price trends from products already in the market can be used to inform investment decisions of new products and technologies is described.