Developing guidance for budget impact analysis

The role of economic evaluation in the efficient allocation of healthcare r esources has been widely debated. Whilst economic evidence is undoubtedly u seful to purchasers, it does not address the issue of affordability which i s an increasing concern. Healthcare purchasers are concerned not just with maximising efficiency but also with the more simplistic goal of remaining w ithin their annual budgets. These two objectives are not necessarily consis tent. This paper examines the issue of affordability, the relationship between af fordability and efficiency and builds the case for why there is a growing n eed for budget impact models to complement economic evaluation. Guidance cu rrently available for such models is also examined and it is concluded that this guidance is currently insufficient. Some of these insufficiencies are addressed and some thoughts on what constitutes best practice in budget im pact modelling are suggested. These suggestions include consideration of tr ansparency, clarity of perspective, reliability of data sources, the relati onship between intermediate and final end-points and rates of adoption of n ew therapies. They also include the impact of intervention by population su bgroups or indications, reporting of results, probability of re-deploying r esources, the time horizon, exploring uncertainty and sensitivity analysis, and decision-maker access to the model. Due to the nature of budget impact models, the paper does not deliver stringent methodological guidance on mo delling. The intention was to provide some suggestions of best practice in addition to some foundations upon which future research can build.