انواع ارزيابي های اقتصادي سيدرضا مجدزاده مرکز تحقيقات بهره برداری از دانش سلامت و دانشکده بهداشت دانشگاه علوم پزشکي و خدمات بهداشتي درماني تهران

2 Roadmap  Health economics vs economic evaluation  Types of Analysis CEA vs. CUA  Key messages and discussion questions

3 Where are we?  Types of Analysis CEA vs. CUA  Key messages and discussion questions

4 “In Canada there is a small radical group that refuses to speak English and no one can understand them they are called economists.”

5 Health Economics Vs Economic Evaluation?  Health economics is concerned with the choice over how best to spend limited resources available for health care.  Economic evaluation is a tool to assist with determining which interventions are preferred given both the scarcity of resources and the need to make choices.

6 HEALTH ECONOMICS ECONOMIC EVALUATION OF HEALTH CARE INTERVENTION

Cost of Illness Studies

8 Justifications for Cost of Illness Studies  Highlight the importance of a disease  Can provide a baseline for assessing the impact of alternative programs  Can help determine medical research prioirites

9 Why Estimate Burden of Disease  Estimates of the burden of diseases do not in themselves facilitate resource allocation  Burden of diseases provide a baseline from which to asses the impacts of programs designed to effect the epidemiology of disease  Burden of disease estimates also provide a basis from which to assess the value of further research  Potentially useful in analyzing trends

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11 Economic Evaluation of Health Care Interventions  A systematic framework to assess the relative costs and benefits of alternative health care interventions.  By choosing to provide interventions that are deemed "cost-effective", health care provision should be more efficient and health benefits should increase

12 Definition of Health Economic Evaluation The comparative analysis of alternative courses of action in terms of BOTH their costs and health consequences

13 Nature of an Economic Evaluation Target Group New Intervention Alternative Intervention Impact on health status i.Survival ii. Quality of Life i. Hospitalizations ii. Pharmaceuticals iii. Procedures iv. Patient costs Impact on costs Impact on health status Impact on costs i.Survival ii. Quality of Life i. Hospitalizations ii. Pharmaceuticals iii. Procedures iv. Patient costs v. Community health care

Example Entacapone Usual Care Impact on health status i.Improvement in clinical status ii. Quality of Life i. Hospitalizations ii. Pharmaceuticals iii. Equipment costs iv. Patient and caregiver costs Impact on costs Impact on health status Impact on costs i.Improvement in clinical status ii. Quality of Life i. Hospitalizations ii. Pharmaceuticals iii. Equipment costs iv. Patient and caregiver costs v. Community health care Severe Parkinson’s Disease

15 Incremental cost-effectiveness ratio = $20,000 - $10, years years = $10,000 per life-year gained Calculation of Cost Effectiveness

16 Incremental Analysis

17 Comparing Alternative Programs

18 Incremental Analysis

19 CONSIDER A NEW INTERVENTION, e.g. A NEW ANTIHYPERTENSIVE More effective Or Less Side-effects Or More Convenient Less Physicians Consults? Less or Shorter Hospitalisation? Less or Cheaper Interventions? Less Other Drugs? Less Tests and Imaging? IF THEN

20 Where are we?  Health economics Vs economic evaluation  Types of Analysis CEA vs. CUA  Key messages and discussion questions

21 Range of Costs  Choice of perspective depends on question at hand and target decision maker  Ideally should consider all relevant costs and benefits/harms Can create a clinical pathway to determine all relevant events then determine important resource consequences Can collect all data prospectively alongside an RCT

22 Types of Analysis  There are four distinct types of economic analyses in health care Vary by their measurement of the benefit of treatment  Measurement of resource use is similar in each method

23 INPUTSPROCEDUREOUTPUTS

24 RESOURCES CONSUMED HEALTH CARE PROGRAM HEALTH IMPROVEMENT COSTSEFFECTSUTILITIESBENEFITS (C) (E) (U) (B) E - HEALTH EFFECTS IN NATURAL UNITS U - HEALTH EFFECTS AS A MULTI-DIMENSIONAL PHENOMENON MEASURED IN NON-MONETARY UNITS (e.g. QALYs) B - HEALTH EFFECTS IN DOLLARS

25 Types of Analysis

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32 Where are we?  Health economics Vs economic evaluation  Types of Analysis CEA vs. CUA  Key messages and discussion questions

33 Outcomes in CEA vs. CUA CEA  Single  Programme-specific  Unvalued CUA  Single or multiple  General  Incorporate notion of value

34 CONSIDER A NEW INTERVENTION, e.g. A NEW ANTIHYPERTENSIVE More effective Or Less Side-effects Or More Convenient Less Physicians Consults? Less or Shorter Hospitalisation? Less or Cheaper Interventions? Less Other Drugs? Less Tests and Imaging? IF THEN

35 Quality Adjusted Life Years (QALYs)  Most common outcome measure in cost- utility analysis  Method of placing a value on both mortality and morbidity to facilitate combination into one measure of benefit

36 Quality-Adjusted Life Years (QALYs) Living for 3 months confined to a hospital for TB treatment was worth only 1.8 months of regular time (0.60 X 3 months)

37 How do we measure QALYs?  Sum The duration of the health state Multiplied by the quality weight for this health state  Goal? Maximize total benefits (in terms of QALYs) in a society

38 EXAMPLE (1)

39 EXAMPLE (2)

40 Elements of a QALY  Projected life expectancy (for a given health state) Clinical data  Survival analysis  Actuarial methods “Life Tables”  Model-based analyses  QALY weights Diverse techniques…

41 HRQoL Weights: Conditions  Based on preferences, not on health state measures (SF-36, SF-12)  Measured on an interval scale Identical gains and losses are equivalent 0.2 to 0.3 equal to 0.8 to 0.9  Scale has no natural 0, 0 = death 1= full health

42 Where are we?  Health economics Vs economic evaluation  Types of Analysis CEA vs. CUA  Key messages

43 Key Messages  Economics more than just costs  Variety of methods – varying by outcome measure