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Below please find a selective list of recent publications: Preview: M. Schlander, O. Schwarz, A. Rothenberger, V. Roessner:
M. Schlander:
Recent Publications: M. Schlander: "In recent years there has been a proliferation of health
technology assessment (HTA) initiatives internationally. The National
Institute for Health and Clinical Excellence (NICE) in England and
Wales stands prominently among these initiatives. The current study
reviews the NICE appraisal process, confirms the transparent, inclusive
and participatory nature of the appraisal, but identifies a number
of inconsistencies in the assessment itself and problems in the
way the evidence was presented. Having identified these shortcomings,
the study at hand offers significant lessons for policy makers,
not only in England and Wales, but in other settings as well."
"While the focus of this monograph is the NICE ADHD analysis
and appraisal process, the careful step-by-step critique might be
used as a guide for future appraisal processes, not just for NICE,
but for all health care policy analysts as well." "This is a remarkable piece of work which is indicative of
a scholar who is totally on top of his subject area and capable
of expressing his ideas in lucid prose. ... It is timely to puncture
the self-congratulatory culture which is developing amongst health
economic evaluators. ... A particular strength of the monograph
is the evaluation of the process using Daniels and Sabin’s
“accountability for reasonableness” (A4R) framework
and especially as this is advocated by NICE. It is a shame that
NICE did not perform better. ... The scope of the author’s
analysis in the final chapter is impressive. … The issues
raised are those which will determine the future of the evaluation
process both at the level of application and the conceptual framework."
M. Schlander: Cost benefit analysis has been greeted with skepticism in the health policy field, primarily owing to resistance to a monetary measure of benefit and owing to concerns that willingness to pay may be unduly influenced by ability to pay. The move to cost utility analysis (CUA) however has not been without problems. The framework deviates from economic theory in important aspects and rests on a set of highly restrictive assumptions, some of which must be considered as empirically falsified. Results of CUAs do not seem to be aligned with well-documented social preferences and the needs of health care policy makers acting on behalf of society. By implication, there is reason to assume that a context-independent value of a quality-adjusted life year (QALY) does not exist, with potentially fatal consequences for any attempt to interpret CUAs in a normative way.
M. Schlander, G.-E. Trott, O. Schwarz:
T. Reinhold, B. Brüggenjürgen, M. Schlander, et al.:
M. Schlander, G.-E. Trott, O. Schwarz:
M. Schlander:
M. Schlander, M. Beck:
M. Schlander:
M. Schlander: Subject: Seeking to combine legitimacy and pragmatism, and realizing that utilitarianism'has next to nothing to offer in eradicating health inequalities', NICE put aside questions of whether matters of content can be resolved solely with a reference to 'due process' and explicitly subscribed to the principles of accountability for reasonableness. The paper reveals that NICE has not yet met its stated objective to fulfill the conditions of accountability for reasonableness
M. Schlander:
M. Schlander: Subject: A previous critical analysis of NICE Technology Appraisal No. 98 revealed a number of issues which must cast doubt on the robustness of the NICE approach. In this paper, potential underlying problems will be explored, followed by a discussion of lessons for international health care policy makers. The paper is intended to be an invitation to further debate and inquiry.
M. Schlander: Subject: The National Institute for Health and Clinical Excellence is widely regarded as a role model for the implementation of Health Technology Assessments (HTAs) including economic evaluation. Somewhat unexpectedly, the present analysis does not confirm the robustness of the NICE approach when addressing complex clinical decision problems.
M. Schlander:
M. Schlander: Subject: Based on the Nordbaden project, key information is summarized on administrative prevalence, physicians involved in care, and drug treatment of attention-deficit/hyperactivity disorder (ADHD) in Germany. Part of a special issue of psychoneuro on ADHD.
M. Schlander, O. Schwarz, G.-E. Trott, M. Viapiano, N. Bonauer: Subject: This is the first full publication based on the Nordbaden project for health care utilization research. Insights are presented on the age and gender specific administrative prevalence of ADHD in Germany and on physician involvement in health care provision for these patients.
M. Schlander: Subject: Recently, a group of European clinicians proposed a treatment guideline covering the use of long-acting medications for the hyperkinetic disorders. These recommendations are discussed in light of currently available economic evaluations.
E.M. Foster, P.S. Jensen, M. Schlander, W.E. Pelham Jr., Subject: Analyses of costs and effectiveness of treatment for ADHD must consider the role of therapeutic objectives and comorbidities. From a United States payers' perspective, high-quality medication management appears cost-effective at all levels of willingness to pay. For some comorbid conditions, however. pychosocial interventions (alone or in combination with medication) may become cost-effective choices at higher levels of willingness to pay, too.
M. Schlander: Subject: A preliminary analysis of the NICE technology appraisal based on a qualitative case study. While the process adhered to predefined timelines and appeared highly (albeit not perfectly) transparent, questions remained regarding fulfillment of the conditions of relevance, appeal, and enforcement under "accountability for reasonableness".
P.S. Jensen, J.A. Garcia, S. Glied, M. Crowe, E.M. Foster, Subject: Attention-Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. This paper presents the first economic analysis of clinically proven ADHD treatment strategies based upon the MTA study, the largest clinical trial conducted in this field to date. Findings were first presented at the IACAPAP World Congress in Berlin, August 2004, and at the Annual Meeting of the German Association of Child and Adolescent Psychiatrists and Psychologists (BKJPP), held in Gelsenkirchen, Germany, November 2004. See also here.
M. Schlander: Subject: After three decades of health care cost containment in Germany, enactment of the most recent reform (GMG) marks a watershed: apparently, the potential has been largely exhausted for further savings in pharmaceutical spending. Yet the new drugs segment maintains its role as a growth driver, owing to the continuing shift from older to new, and frequently more expensive, products. It is argued that formal health economic evaluations would be required to better differentiate pharma-ceutical products based on their incremental value or "cost-effectiveness ratio". Further tightening of pharmaceutical component management in Germany may well result in increasing underuse of effective products ("static" inefficiency) as well as in ("second order") dynamic inefficiencies. For an abstract, please see here.
M.
Schlander, O. Schwarz: Subject: Future health spending in Germany may rise at a faster
rate than the economy as a whole, expressed by increase in gross
domestic product (GDP). Abstracting from distributional issues, we
analyze how "affordability" depends on real economic growth.
Result: At real annual per-capita GDP growth rates exceeding one
percent, we find "affordability" For an abstract, please see here.
M. Schlander: For further information, please see here.
M. Schlander, O. Schwarz, C. Thielscher: Subject: It is proposed to differentiate more clearly between affordability of (or ability-to-pay for), financing of (or actual flow of funds for), and willingness-to-pay for health care. Based on a comprehensive review of the literature on growing health care expenditures and existing projections of future spending trends, an analysis is presented of the macroeconomic affordability of a two-percentage point gap between the rates of health care spending and economic growth. It is shown that affordability is highly sensitive to low economic growth rates, whereas at GDP growth rates exceeding one percent, affordability can be expected for the next several decades. This manuscript is available for download.
M. Schlander: Subject: Increasing relevance of health economics for health care providers and patients involved with Attention-Deficit/Hyperactivity Disorder (ADHD). An introductory text delineating some fundamental principles of economic evaluation, combined with a review of the literature on the economic implications of ADHD. It is argued that three multiplicative factors may lead to escalating costs associated with the treatment of ADHD in Germany: increasing diagnostic prevalence, growing acceptance of pharmacotherapy, and higher unit costs of novel medications.
M.
Schlander Subject: German pharmaceutical market dynamics and evaluation of innovative new products. New regulations, enacted with the health care reform of 2003/2004, are discussed against the background of international experience. Emphasis is placed on the "fourth hurdle" and cost-effectiveness analyses. Paper in German.
M. Stadler, M. Schlander, M. Braeckman, T. Nguyen,
J.G. Boogaerts: Subject: economic evaluation of a nurse-based acute pain service in a general hospital in Belgium. For an abstract, please see here.
M. Schlander, C. Thielscher, O. Schwarz:
M. Schlander: Subject: German health care modernization act ("GKV-Modernisierungsgesetz", GMG). A critique of the approach chosen to discriminate between innovative and me-too pharmaceuticals, combined with some hints on alternatives. Paper in German.
M. Schlander: Subject: the logic of cost-effectiveness. A brief description of the specific variant of utilitarian thought underlying the decision rules of cost-effectiveness analysis.
M. Schlander: Subject: The “fourth hurdle” for new pharmaceutical products and its alternatives. Written for non-economists, the paper provides ten reasons why pharmaceutical markets can be regulated effectively without resorting to a “fourth hurdle”. It describes, in some detail, a feasible alternative to fourth hurdle regulation. Though available to the members of the Health Care Committee of the German Parliament, the paper apparently failed to influence the consensus negotiated by Social Democrats, Christian Democrats, and the Green Party that became the basis of the German health care modernization act (GMG) of 2003/2004.
F. Gantner, C. Schweiger, M. Schlander: Subject: Innovation management in the pharmaceutical industry. Successful positioning strategies increasingly need to go beyond trademark selection and branding: in certain situations, identifying an appropriate International Nonproprietary Name (INN) may be essential for classification and, hence, differentiation of new compounds.
M. Schlander: Part 1: Why Rationing will become Inevitable. Medizinische Welt 50 (1999) 210-216, 140-147, 83-90, and 36-41. Subject: Principles of health economic thinking for physicians. A series of four papers addressing fundamental problems of rational resource allocation in the health care system. Written in German; English abstracts available.
M. Schlander: Subject: The roles of health economics (“pharmacoeconomics”) in the pharmaceutical corporation. A paper discussing stakeholder dynamics, changes in the pricing and reimbursement environment, and the strategic role of health economics.
M. Schlander: Subject: Cost-sharing policies and their effects. The paper (written in German) also includes a brief discussion of some key lessons from the RAND Health Insurance Experiment.
M. Schlander: A monograph dating back to 1998. Written before the inception
of the National Institute for Clinical Excellence (NICE), it is
now incomplete on an important subject matter, not to say outdated.
Outsold. One of the few remaining copies may be obtained from the
author. |
