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Exploration of HealthCoin: A Currency to Address US Private Payer Underfunding for Single or Limited Administration (SLA) Treatments with Long-term Effectiveness
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| 자료유형 | 학위논문 |
|---|---|
| 서명/저자사항 | Exploration of HealthCoin: A Currency to Address US Private Payer Underfunding for Single or Limited Administration (SLA) Treatments with Long-term Effectiveness. |
| 개인저자 | Banks, Jordan T. |
| 단체저자명 | University of Washington. Health Services. |
| 발행사항 | [S.l.]: University of Washington., 2019. |
| 발행사항 | Ann Arbor: ProQuest Dissertations & Theses, 2019. |
| 형태사항 | 147 p. |
| 기본자료 저록 | Dissertations Abstracts International 81-03A. Dissertation Abstract International |
| ISBN | 9781085714952 |
| 학위논문주기 | Thesis (Ph.D.)--University of Washington, 2019. |
| 일반주기 |
Source: Dissertations Abstracts International, Volume: 81-03, Section: A.
Advisor: Basu, Anirban. |
| 이용제한사항 | This item must not be sold to any third party vendors.This item must not be added to any third party search indexes. |
| 요약 | There may be a free-rider problem stemming from the distribution of future medical savings from single or limited administration (SLA) treatments with lifetime efficacy. Private commercial insurance through an employer is the biggest source of health insurance among the working age population in the United States. A commercial plan can only benefit from avoided future medical costs or additional QALYs gained for patients for paid treatments while a patient remains on their plan. Any benefit after the age of 65 is reaped by the Centers for Medicare and Medicaid Services (Medicare) from QALYs and avoided costs that are realized while patients are covered by Medicare. The free-rider problem is primarily due to a framework of decision-making that does not include any avoided medical costs or QALY gains after the age of 65 for plan members. This dissertation proposes the free rider incentives will impact the market through delayed or reduced access to cures and SLA therapies. We posit this will occur because SLA treatments will be valued less compared to treatments which are lower cost in the short-term and generate benefit while the patient is being treated (i.e., chronic), given the same overall benefit from the treatments while the patient is on the plan.This dissertation focuses on the misalignment in incentives that occurs because the payer for the patient changes at the age of 65, from private commercial payers to Medicare. The aim of this dissertation is to evaluate the need, feasibility, and potential values of HealthCoin in relevant markets. HealthCoin is a policy mechanism to correct underfunding of curative treatments in disease areas where they are available. We used three aims to achieve this goal. The first to demonstrate potential underfunding of SLA therapies in private plans and the second and third to demonstrate the feasibility and value distribution implications for HealthCoin in two markets where SLA therapies are developing.Aim 1 examined if there is evidence that private payers are underfunding SLA therapies before patients enter Medicare. The results from Aim 1 were consistent with underfunding of SLA therapies in the private market. There was a discontinuous increase in the treatment rate where it was expected as patients entered Medicare, but not the chronic falsification study group where there is no underfunding expected. The research suggests there is a need to understand the impact of underfunding across the patient lifetime and in specific disease states with SLA therapies in development and currently used in treatment.Aim 2 demonstrated HealthCoin could alleviate underfunding incentives through HealthCoin where cost-effectiveness thresholds for a QALY is $50,000. For lower cost-effectiveness thresholds, Medicare is not incentivized to provide HealthCoin because the net value to the health care sector is negative. At higher cost-effectiveness thresholds, private payers are incentivized to provide chimeric antigen receptor T-cell (CAR T) without the aid of Medicare because the benefits realized will be positive, based on the model assumptions and list price of $475,000.Aim 3 builds on aims 1 and 2 with a model for the potential value and feasibility of HealthCoin in the emerging hemophilia A and B gene therapy treatment markets. In the primary model of this aim, stakeholders are incentivized to participate in HealthCoin for a $250,000 gene therapy price, where the cost-effectiveness threshold is $100,000/QALY, providing a total population benefit of $92 million while patients are under the age of 65 and costing private payers $58 million. HealthCoin creates $11 million in benefit for the population while on Medicare, costing the public payer $26 million. In the hemophilia market, sensitivity analyses are vital because the gene therapies are still in development and there is uncertainty around their duration of efficacy and total target population. Sensitivity analyses in aim 3 revealed that HealthCoin may pass the market for lower thresholds or not at all, depending on price, approved ages of treatment, target population, and duration of efficacy.Through the three Aims, we put forth evidence for the need and potential of a value-based financial tool (HealthCoin) to address the potential underfunding of SLA treatments. Our work indicates that further research is necessary to examine the magnitude for underfunding of SLA treatments in specific disease states. The second and third aims demonstrate that HealthCoin can increase net benefits for the health sector for specific diseases as more high cost SLA therapies are launched in the market. This dissertation suggests HealthCoin is a viable financial tool to redistribute the costs of SLA therapies in alignment with lifetime benefits realized for payers and patients, with opportunities for future research as markets develop.Funding Disclosures: There were no external funding sources responsible for funding this dissertation research. |
| 일반주제명 | Health care management. Economics. |
| 언어 | 영어 |
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