Project: Economic Value of Hypotension Control (US/EU)

Partners/Funding: Fortune 1000 Health Technology Firm, Top 5 Academic Medical Center, Health Economics Colleagues

Issue: While the epidemiological evidence that hypotension control improves health outcomes had mounted; the financial implications, particularly from a payer and provider view, were poorly understood. In order to help establish the economic value for key stakeholders, such as hospitals, two economic simulation models were developed.

Role: In concert with physician (KoL) input, HFAAI conducted an exhaustive literature review of relevant clinical, epidemiological and economic papers. Based on literature inputs, expert review and a recent hospital EMR epidemiological analysis, two Monte Carlo simulation were developed to estimate the associated costs (per surgery) for improved hypotension monitoring for non-cardiac surgical patients and ICU patients. Additional analyses were conducted for EU as well as for variable levels of hypotension.

Outcome: HFAAI developed multiple conference presentations and two manuscripts. The research was subsequently published in two peer-reviewed journal articles and presented at multiple national medical and health outcomes conferences to help stakeholders understand the economic value that diagnostic technology confers in the detection of hypotension during non-cardiac surgery and in the ICU.

Project: Novel Oncology Diagnostic Tool (US)

Partners/Funding: Oncology Diagnostic Startup, Physician Partners, Health Economists

Issue: Start-up in oncology diagnostics space entering clinical trials wanted to estimate the potential future value of their technology to the health system and payers.

Role: HFAAI evaluated existing evidence, internal documents and published economics and clinical literature to generate an estimate of the potential impact on operation costs, short-run health system financial offsets and long run expenditure reductions to help frame the value for the firm and potential additional investors across a range of cancer types. HFAAI also generated a more detailed Monte Carlo simulation of the technology within specific cancer type.

Outcome: Armed with additional economic evidence, the firm is proceeding with clinical trials and development.

Project: Private Sector Hospital Financial Analysis (Middle East)

Partners/Funding: USAID, Global Health NGO (Non Governmental Organization), Ministry of Health (MOH), Ministry of Finance (MOF), Private Hospital (Senior Executives), World Bank, Donors

Issue: USAID/NGO sought a health economist to assess the financial condition of private hospitals and MOH/MOF in order to develop a repayment schedule for government debts owed to private hospitals. In addition, USAID/Global NGO sought to evaluate existing and potential new pricing/financing mechanisms for services provided by private hospitals to government payers.

Role: HFAAI developed a mixed methods approach including in-depth-interviews with all stakeholders (e.g. Minister of Health, Accountant General, Hospital CEOs/CFOs), thorough review of financial and health system data/government reports/literature, surveys and econometric/quantitative analyses on relevant price and volume datasets.

Outcome: Based on financial analyses, MOH/F established a repayment schedule for private hospitals. Partners (WB/WHO/USAID/NGO) are enhancing efforts to adjust reimbursement mechanisms and address long-run cost growth for tertiary care while ensuring financial sustainability of private hospitals.

Project: Trade Policy and Access to Medicines (Middle East)

Partners/Funding: USAID/USG, Global Health NGO (Non Governmental Organization)

Issue: Having identified access to medicines as an important issue in prior research in a Middle Eastern market, USAID/NGO contracted with HFAAI to assess how the trade and industrial policy impacted the supply, manufacture, pricing and availability of medicines in domestic and foreign markets.  In addition, USAID/Global NGO sought to evaluate possible policy options that may address access to medicines.  

Role: During the three-month engagement, HFAAI conducted qualitative and quantitative research, relied on in-country interviews and discussions with various high level stakeholders (Minister of Health, Minister of Finance/Accountant General, MoH Pharmacy Director, US Government/EU/WHO leadership), evaluated financial and health system data/government reports/literature/surveys for MOH/MOF/World Bank and developed econometric/quantitative analyses on relevant price and volume datasets. 

Outcome: Presented options to USAID/USG/NGO that addressed access to medicines via potential local and regional trade policy reforms and highlighted the key role that market or government institutional development (e.g. supply chain, local subsidies and human resource development) would have on long-run prices and access to medicines. 

Project: Hospital Budget Impact Model (BIM) for an Angioplasty-related Product (US)

Partners/Funding: Fortune 100 health/technology firm, Contract Research Organization (CRO), Cardiology key opinion leaders (KOLs)

Issue: After generating clinical evidence of demonstrating reduced complications in angioplasty, the pharmaceutical firm aimed to demonstrate the financial value of its product to hospitals in a peer-reviewed academic publication.

Role: In conjunction with the CRO and KOLs, HFAAI led the development of the budget impact model, served as first author and marshaled the manuscript through the peer-review process.

Outcome: The BIM was published in Journal of Medical Economics (less than 3 months between initial submission and publication). The evidence serves as an important, objective tool to expand product adoption.

Project: US Hospital ROI Model for Novel Medical Technology (Asia, US)

Partners/Funding: Asian Health Technology Firm, existing marketing consultant, academic thought-leader on hospitals

Issue: Start-up firm with long track record of successful medical technology innovation among senior leadership wanted to understand the value of an emerging technology from the perspective of a key customer in the US market: hospitals. Client also wished to understand if it should move forward with investing in the early stage technology.

Role: In concert with marketing partner and academic reviewer, HFAAI consolidated quantitative and qualitative inputs to develop a hospital-focused ROI model. The model estimated potential market size across different types of hospitals and informed what the valid price range would be for their product in development based on a range of various effectiveness assumptions. A secondary ROI was also developed from the perspective of the health technology firm.

Outcome: Armed with both ROI models, the client moved forward with plans to further invest internal funds for R&D in the technology. The firm also used our rigorous analysis to attract additional investors.

 Project: Financial Analysis of Medicine Supply and Purchasing Program for MoH Hospitals (Middle East)

Partners/Funding: USAID/USG, Global Health NGO (Non Governmental Organization), Ministry of Health (MOH), Ministry of Finance (MOF)

Issue: USAID/NGO contracted with HFAAI to evaluate if improvement in the supply of medicines via increased purchasing (and a more efficient supply chain) would result in net health care expenditure reductions for the MoH by reducing costly referrals to private hospitals from the state system.

Role: During the three-month engagement, HFAAI conducted qualitative and quantitative research, relied on in-country interviews and discussions with various high level stakeholders (Minister of Health, Minister of Finance/Accountant General, MoH Pharmacy Director, US Government/EU/WHO leadership), evaluated financial and health system data/government reports/literature/surveys for MOH/MOF/World Bank to develop a Monte Carlo budget impact model that estimated expected net cost reduction for the MoH.

Outcome: The model presented to USAID/USG and MoH demonstrated that cost savings would be in the range of 3-6% of the MoH overall budget. The pharmacy department aimed to ensure that medicine stock-outs did not persist via improved purchasing going forward.

Project: Global Market Forecast for a Product indicated in Stem Cell Transplant. (US, EU)

Partners/Funding: Global specialty pharmaceutical firm (marketing and finance divisions), Contract Research Organization (CRO)

Issue: Specialty pharmaceutical firm with recently in-licensed product required validation of demand estimation model to help evaluate future potential revenue in US and EU over a 15 year horizon.

Role: HFAAI partnered with an expert oncologist (CRO) to develop an econometric demand model which accounted for demographic trends, stem cell transplant treatment patterns, epidemiological projections, health system factors and current/future potential technological shifts for both the US and EU markets.

Outcome: Client updated their revenue forecasts and relied on the robust analysis to align previously divergent views across divisions with respect to market potential and product value.

Project: US Market Analysis for Novel Revascularization Device (US, EU)

Partners/Funding: EU-based Medical Device Firm, Contract Research Organization (CRO)

Issue: A VC-funded medical device manufacturer with recent CE mark approval in the EU for their unique therapeutic intervention wished to evaluate market demand, reimbursement and entry strategy for the US market.

Role: HFAAI partnered with CRO to evaluate epidemiological data, health economics/finance models, reimbursement for comparable devices and policy options/regulatory opportunities in the US context.

Outcome: HFAAI and the CRO partner developed a summary presentation with valid volume and price data to inform senior management (CEO) and investors of the market potential in the US as well as key factors that will impact projected revenues. Specific emphasis was also placed on CMS reimbursement regulatory options for novel devices.

Project: Global Financing of Health Worker Production for the UN 2030 Sustainable Development Goals (SDGs) (Global)

Partners/Funding: World Health Organization, IntraHealth International

Issue: WHO aimed to estimate the resources required to train and hire sufficient physicians, nurses and health workers in order to meet the United Nations 2030 Sustainable Development Goals (SDGs).

Role: HFAAI led the development of the costing model which integrated analyses of financial statements, qualitative expert opinion, careful literature review, several multivariable regression estimations and epidemiological models. The final robust model identified the anticipated capital and recurrent costs expected over time to train the next generation of health professionals in order to meet the 2030 SDG targets. We collaborated with academics, NGOs and, of course, WHO to develop and refine the costing model.

Outcome: WHO will be able to present the data internally and to other stakeholders in health ministries, finance ministries, multilateral institutions and other potential funders to motivate and coordinate financial planning aimed at supplying the optimal level of health workers across a range of planning scenarios to health systems worldwide by 2030.

Project: Optimal Incentives for Rural Health Workers (Asia)

Partners/Funding: USAID, IntraHealth International, Loa PDR Ministry of Health

Issue: USAID and IntraHealth sought to identify the optimal bundle of incentives to voluntarily locate physicians and nurses into rural areas

Role: HFAAI combined existing discrete choice experiment (DCE) data, costing surveys and WHO data linking health worker density and outcomes to estimate A) how 15 different incentive bundles affected the probability locating in a rural area, B) the cost of each of the bundles and C) the implications for health outcomes over time in Lao PDR for each bundle. In combining these results HFAAI characterized the cost effectiveness of each of the policy options and identified the optimal voluntary policy approach.

Outcome: The study was published in Medical Care and Lao PDR Ministry of Health incorporated the results into their policy formulation process for health workers.

Project: Global Spending on Physician and Nurse Pre-Service Education (Global)

Partners/Funding: World Bank, China Medical Board, Bill & Melinda Gates Foundation, Rockefeller Foundation, The Lancet

Issue: The Global Independent Commission for Education of Health Professionals for the 21st Century, led by Dean Julio Frenk of Harvard School of Public Health, sought to develop a model which would estimate the annual global and regional spending by medical schools and nursing schools for pre-service training (prior to residency). This is a particularly complex issue as the estimate had to A) try to capture cross-subsidies from the service delivery, research functions or other institutional grants from outside the core health education delivery unit and B) account for capital and operating expenditures.

Role: HFAAI collaborated with academics, NGOs and the World Bank and combined a review of academic and grey literature, internal World Bank reports and UN/WHO/World Bank/NGO data to develop econometric models to estimate country and regional level spending on physician and nurse education institutions. We generated the technical report and provided the foundation for the economic dimensions of the report.

Outcome: The Commission published their report in The Lancet and has subsequently motivated local, country, regional and global institutions to improve their health worker policies.