As health care costs continue to rise, medical communicators can play a role in health care policy and practice by participating in Health Economics and Outcomes Research (HEOR)—a growing field with opportunities for medical communicators.
What is HEOR, and how does it contribute to scientific knowledge? What are the guidelines for reporting results of HEOR studies?
HEOR is a way to assess the clinical and economic impact of treatments. It brings together data from studies of interventions and real-world care, and it also includes certain types of modeling studies. HEOR information is often used by insurance plans and health care institutions to decide which drugs or equipment to cover.
In an AMWA Journal article based on a conference presentation, “What Is Health Economics and Outcomes Research? A Primer for Medical Writers,” author Caitlin Rothermel, MA, MPH, introduces medical communicators to the contours of HEOR analyses.
“Because of the progressive rise of health care expenditures, HEOR analyses are being given closer attention in the United States,” writes Rothermel. “For some time, health care costs have been rising at more than the average rate of inflation. These rising expenditures are driven, in part, by increased rates of chronic disease, as well as a heightened volume of care (in which new treatments are introduced, expanding the spectrum of care, but without replacing existing treatments).”
Fundamentally, HEOR studies compare the costs of treatments on various dimensions.
Rothermel’s article introduces medical communicators to the most common types of health economic analyses.
Common Types of HEOR Studies
Retrospective database analysis. These analyses evaluate health care utilization as it occurs in routine clinical care. Typically, these studies obtain information from patient databases, which are maintained by payers and other organizations.
Budget impact analysis (BIA). This kind of study looks at the full, projected costs of implementing a treatment or intervention for an organization or health plan.
Cost-effectiveness analysis (CEA). These studies measure differences in costs among several treatments, taking patient outcomes and preferences into account.
Cost-utility analysis (CUA). These analyses take into account the years of life and quality of life gained when looking at specific treatments.
The main data categories used for HEOR studies are direct medical costs, direct nonmedical costs, indirect costs, and intangible costs.
Direct medical costs include medication and the steps associated with delivering medication, including counseling, administration, diagnostic tests, and monitoring.
Direct medical costs also include patient services like outpatient visits, hospitalizations, clinic visits, ambulance services, and nursing.
Direct nonmedical costs include patient expenses like travel, services related to their health condition, hotel stays for family, or childcare.
Indirect costs may be assessed for lost productivity for patients or caregivers.
Intangible costs relate to the impact of the health condition on the patient’s quality of life and emotional and mental health; this can include pain and suffering, fatigue, and anxiety.
High-quality HEOR research is clear about the perspective of the analysis—ie, for whom are these costs being measured? “If the perspective is that of the payer (an insurance company or national health care system), the analysis is likely to consider direct medical costs that accrue to the health plan over the short or long term,” writes Rothermel. The perspective could also be that of a hospital, or even societal.
Some types of health economics research are based on modeling techniques that require specialized software. Modeling approaches used by researchers include decision trees, which compare two treatment options, and Markov modeling, used to compare multiple treatment options with a more complex range of potential outcomes.
ICERs and QALY
Retrospective database studies and BIAs typically use straightforward language and mathematical concepts. For evaluating CEAs, a couple of key concepts to understand are incremental cost-effectiveness ratios (ICERs) and quality-adjusted life years (QALYs).
The ICER, according to Rothermel, answers the question, “How does one treatment compare with another, in terms of costs and outcomes?” Essentially, the ICER is the ratio of the difference in cost divided by the difference in outcomes. A negative ICER means that one treatment is clearly more effective and less expensive. If the ICER is positive, other factors must be considered to determine which treatment is preferable, and in which circumstances.
QALYs look at both the quantity of life and quality of life, combined in a single measure. QALYs are typically applied to research or population-based evaluations, not physician decision-making.
The International Society for Pharmacoeconomics Outcomes and Research has developed the Consolidated Health Economic Evaluation Reporting Standards, or CHEERS. Now in its second edition, CHEERS provides detailed recommendations and a checklist for reporting HEOR data for publication.
The Role of the Medical Writer
Health economics research has been growing and expanding, represented by journals such as Health Economics, Journal of Health Economics, Journal of Managed Care Pharmacy, and Value in Health.
In Rothermel’s AMWA Journal article, she identifies skills and qualities that medical writers can bring to HEOR projects; these include a high level of comfort working with and fact-checking numbers and data, and a concise writing style.
Introduction to HEOR
For medical communicators interested in pursuing the growing opportunities in health economics, AMWA offers a webinar, “Introduction to Health Economics and Outcomes Research (HEOR) for Writing Professionals.” The course provides an overview of HEOR and a look at real-world evidence (RWE) and patient-reported outcomes (PRO), two key components of HEOR studies.
It also covers types of HEOR content such as Academy of Managed Care Pharmacy (AMCP) and global value dossiers, literature reviews, economic models, manuscripts, and review articles.
Together, we can explore the fascinating world of HEOR, which exists at the intersection of health care policy and practice.
We thank Caitlin Rothermel, MA, MPH, who contributed her expertise to this blog.