Cost Effective Studies Group 8 Cameron Durlacher, Nicholas Mastromarino, Yudeysi Morejon, Bora Na, Reema Rifaie

Objectives Explain & provide an example of a practical pharmacy cost effectiveness study Objective of cost – effective studies Methods Results Conclusions

Objectives of the Study Compares the costs and health outcomes of two or more interventions that preform the same task by assessing the extent to which it can be regarded as providing value for its cost. Consider which interventions produce the greatest value, based in part on economic implications, as well as effectiveness. Deciding how to allocate health care resources http://hubpages.com/living/cost-effective-2

Objectives of the Study Cost-Effectiveness expressed as a ratio: ( Cost of intervention – Cost prevented by intervention) Benefit of intervention Cost of intervention: associated with provided treatment of preventive test i.e hospitalization, drugs Cost prevented by intervention: avoided future health care cost i.e future hospitalizations, physician visits, drugs Benefit of intervention: usually associated with increased in both quantity and quality of life due to intervention. Quality adjusted life years is usually what is measured (QALY)

Quality-adjusted life-years (QALY’S) QALY’S = Duration of illness x ( HRQL treated – HRQL untreated) + ( years gained x mean HRQL ) HRQL : Health related quality of life – it’s a score that evaluates life lived in a particular health state QALY’S : measured using survey instruments QALY’S is defined as the measure of health improvement that is used to guide health-care resource allocation decisions http://multiple-sclerosis-research.blogspot.com/2014/01/how-does-nice-measure-value-for-money.html

Methods Utilized in Cost Effective Studies Interventions that are completely independent – that is, where the costs and outcomes of one intervention are not affected by the introduction Mutually exclusive – that is, where implementing one intervention means that another cannot be implemented, or where the implementation of one intervention results in changes to the costs and outcomes of another.

The Cost-Effective Plane Less effective and more expensive Excluded* More effective and more expensive Questionable* Less effective and less expensive More effective and less expensive Dominant* Aims to clearly illustrate differences in costs and outcomes between different strategies Visual representation on the relative value of the two strategies Therapy approval for reimbursement and for formulary inclusion Health technology assessment agencies i.e NICE make their judgment based on the relative cost - effectiveness of therapies

The Cost-Effective Plane

EXAMPLE: Practical Pharmacy cost-effective study Ear drop A Ear drop B Cost ( US $) 6.50 7.90 Effectiveness 80% 90% Cost - Effectiveness US $6.50 to treat 0.8 of one case successfully US $7.90 to treat 0.9 of one case successfully Amount (US$) needed to treat one case successfully 6.50/0.8 = 8.125 7.90/0.90= 8.778 Clinical meta-analysis included 4 studies involving a total of 863 participants in observing effectiveness of Ear drop A in comparison to Ear drop B. Overall, the results indicated that Ear drop B had greater incidence of successful treatment with little to no side effects, whereas Ear drop A was less effective in individuals and a slight increase in incidence of adverse events but was not found to have a significant difference

Optimal effectiveness at least expensive Results Price Ear Drop A: $8.1 Ear Drop B: $8.778 Effectiveness Ear Drop A: More Cost Effective Ear Drop B: Less Cost Effective Optimal effectiveness at least expensive Cost-effective

Conclusions of the Study Cost-effectiveness analysis can indicate which one of a number of alternative interventions representing the best value for money Useful in the determination on healthcare outcomes: Determining what should/should not be added to a formulary Determining standard of care practices Determining patient care outcomes Healthcare reform and choosing cost effective healthcare plans

References AH, S. (2015). Affordability and cost-effectiveness: decision-making on the cost-effectiveness plane. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 1 November 2015, from http://www.ncbi.nlm.nih.gov/pubmed/11747050 Bang H, Zhao H. Cost-effectiveness analysis: a proposal of new reporting standards in statistical analysis. Taylor & Francis Group. 2014;24:443-460.10.1080/10543406.2013.860157. Weinstein MC, Torrance G, McGuire A. QALYs: The Basics. International Society for Pharmacoeconomics and Outcomes Research. 2009;12:S5-S-9. http://www.who.int/choice/publications/p_2003_generalised_cea.pdf http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/Cost-effect.pdf

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