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The Role of Learning in Health Technology Assessments: An Empirical Assessment of Endovascular Aneurysm Repairs in German Hospitals

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  • Yauheniya Varabyova
  • Carl Rudolf Blankart
  • Jonas Schreyögg

Abstract

Changes in performance due to learning may dynamically influence the results of a technology evaluation through the change in effectiveness and costs. In this study, we estimate the effect of learning using the example of two minimally invasive treatments of abdominal aortic aneurysms: endovascular aneurysm repair (EVAR) and fenestrated EVAR (fEVAR). The analysis is based on the administrative data of over 40,000 patients admitted with unruptured abdominal aortic aneurysm to more than 500 different hospitals over the years 2006 to 2013. We examine two patient outcomes, namely, in‐hospital mortality and length of stay using hierarchical regression models with random effects at the hospital level. The estimated models control for patient and hospital characteristics and take learning interdependency between EVAR and fEVAR into account. In case of EVAR, we observe a significant decrease both in the in‐hospital mortality and length of stay with experience accumulated at the hospital level; however, the learning curve for fEVAR in both outcomes is effectively flat. To foster the consideration of learning in health technology assessments of medical devices, a general framework for estimating learning effects is derived from the analysis. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

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  • Yauheniya Varabyova & Carl Rudolf Blankart & Jonas Schreyögg, 2017. "The Role of Learning in Health Technology Assessments: An Empirical Assessment of Endovascular Aneurysm Repairs in German Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 26(S1), pages 93-108, February.
    • Handle: RePEc:wly:hlthec:v:26:y:2017:i:s1:p:93-108
    DOI: 10.1002/hec.3466
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    References listed on IDEAS

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    1. Sturm, Roland, 1999. "Cost and quality trends under managed care: is there a learning curve in behavioral health carve-out plans?," Journal of Health Economics, Elsevier, vol. 18(5), pages 591-602, October.
    2. Juan M. Contreras & Beomsoo Kim & Ignez M. Tristao, 2011. "Does doctors' experience matter in LASIK surgeries?," Health Economics, John Wiley & Sons, Ltd., vol. 20(6), pages 699-722, June.
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    Cited by:

    1. Fuchs, Sabine & Olberg, Britta & Perleth, Matthias & Busse, Reinhard & Panteli, Dimitra, 2019. "Testing a new taxonomic model for the assessment of medical devices: Is it plausible and applicable? Insights from HTA reports and interviews with HTA institutions in Europe," Health Policy, Elsevier, vol. 123(2), pages 173-181.
    2. Rosanna Tarricone & Giuditta Callea & Marko Ogorevc & Valentina Prevolnik Rupel, 2017. "Improving the Methods for the Economic Evaluation of Medical Devices," Health Economics, John Wiley & Sons, Ltd., vol. 26(S1), pages 70-92, February.
    3. Michael Drummond & Carlo Federici & Vivian Reckers‐Droog & Aleksandra Torbica & Carl Rudolf Blankart & Oriana Ciani & Zoltán Kaló & Sándor Kovács & Werner Brouwer, 2022. "Coverage with evidence development for medical devices in Europe: Can practice meet theory?," Health Economics, John Wiley & Sons, Ltd., vol. 31(S1), pages 179-194, September.
    4. Rosanna Tarricone & Aleksandra Torbica & Michael Drummond & for the MedtecHTA Project Group, 2017. "Key Recommendations from the MedtecHTA Project," Health Economics, John Wiley & Sons, Ltd., vol. 26(S1), pages 145-152, February.
    5. Sandor Kovács & Zoltán Kaló & Rita Daubner‐Bendes & Katarzyna Kolasa & Rok Hren & Tomas Tesar & Vivian Reckers‐Droog & Werner Brouwer & Carlo Federici & Mike Drummond & Antal Tamás Zemplényi, 2022. "Implementation of coverage with evidence development schemes for medical devices: A decision tool for late technology adopter countries," Health Economics, John Wiley & Sons, Ltd., vol. 31(S1), pages 195-206, September.
    6. Rosanna Tarricone & Aleksandra Torbica & Michael Drummond, 2017. "Challenges in the Assessment of Medical Devices: The MedtecHTA Project," Health Economics, John Wiley & Sons, Ltd., vol. 26(S1), pages 5-12, February.

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