Working Group: Identifying High-Value Health Care

The primary goal of the Identifying High-Value Health Care Working Group is to bring together Penn investigators to build Penn’s capacity to provide high-quality, evidence-based analyses that contribute to the improvement of population health in the United States. Cost-effectiveness analysis is by its nature multidisciplinary, combining clinical medicine, epidemiology, simulation modeling, statistics, economics, and other disciplines, so this working group welcomes investigators from clinical care and related disciplines who share the goal of identifying the best uses of the resources the U.S. devotes to medical care. This working group aims to:

1. Promote collaborations within Penn and with others outside Penn to conduct analyses that inform evidence-based policy;
2. Advise Penn investigators about existing and planned cost-effectiveness analyses;
3. Promote high-quality analyses.

• Advise on Proposal and Manuscript Development: Several times a year, and more often as warranted, the group holds work-in-progress meetings to review and discuss members’ ongoing projects or new proposals. We can provide individualized study design support upon request and as time permits. To receive updates on the next meeting, please sign up here.
• Provide Short Webinars on Key Elements of Cost-Effectiveness Analysis Methods: In addition to discussing principles and resources relevant to a project presented during a work-in-progress session, we have sessions that explain the principles of cost-effectiveness analysis in more depth. The sessions listed below were recorded and are available for viewing at your convenience.
  • “Decision Analysis & Cost-Effectiveness Modeling Using TreeAge Software” presented by Rosa Speranza, MD, January 27, 2023, introduces the simulation modeling software, TreeAge, and shows several applications to clinical problems. Dr. Speranza welcomes inquiries about possible collaborations.
  • “Assembling the Pieces: A Complete Cost-Effectiveness Analysis” presented by Louise Russell, PhD, October 21, 2022.
  • “Rh-immunoglobulin administration for patients with first trimester bleeding: Estimating the cost to the healthcare system” presented by Emma Gilmore, MD, May 6, 2022, is a detailed example of how to “micro-cost” a medical intervention.
  • “Projecting health outcomes: Life expectancy and QALYs” presented by Louise Russell, PhD, March 11, 2022, explains how to use U.S. life tables to project future health outcomes for a cost-effectiveness analysis.
  • “Use of a Non-invasive Medical Device for Early Detection of Postpartum Hemorrhage” presented by Morgan Eilers, Penn undergraduate, Stefanie Modri, MSN, RN, C-MNN, and Kim Trout, PhD, RN, CNM, December 3, 2021, is an example of the kind of clinical issue that members bring to the working group for discussion.
• Provide Links to Key Cost-Effectiveness Readings and Resources.
  • “The Science of Making Better Decisions About Health: Cost-Effectiveness and Cost-Benefit Analysis.” Louise B. Russell. Section IV in Kaplan R., Spittel M., David D. (editors), Population Health: Behavioral and Social Science Insights. AHRQ publication No. 15-0002. Rockville MD: Agency for Healthcare Research and Quality and Office of Behavioral and Social Sciences Research, National Institutes of Health, July 2015.
  • Using Clinical Trial Data to Estimate the Costs of Behavioral Interventions for Potential Adopters: A Guide for Trialists. Russell LB, Norton LA, Pagnotti D, Sevinc C, Anderson S, Finnerty Bigelow D, Iannotte LG, Josephs M, McGilloway R, Barankay I, Putt ME, Reese PP, Asch DA, Goldberg LR, Mehta SJ, Tanna MS, Troxel AB, Volpp KG.Med Decis Making. 2021 Jan;41(1):9-20.
  • We emphasize in our working group sessions that many of the elements that go into a cost-effectiveness analysis can be published as separate papers before the analysis is finished. Here are two examples that use the EQ-5D-3L.
    • Validity of utility measures for women with pelvic organ prolapse. Harvie HS, Lee DD, Andy UU, Shea JA, Arya LA. Am J Obstet Gynecol. 2018 Jan;218(1):119.e1-119.e8.
    • Validity of utility measures for women with urge, stress, and mixed urinary incontinence. Harvie HS, Shea JA, Andy UU, Propert K, Schwartz JS, Arya LA.  Am J Obstet Gynecol. 2014 Jan;210(1):85.e1-6 
  • The EQ-5D is the most widely used system for representing improvements in quality of life in cost-effectiveness analysis. It is a simple set of 5 questions about mobility, self care, usual activities, pain/discomfort, and anxiety/depression with 5 possible answers ranging from no problems to severe problems and is free to researchers. The current version is called the EQ-5D-5L. For more information visit the EuroQoL website.

Working group membership is open to LDI Fellows, and others by invitation. Sign up here.