Economic Evaluation

Economic Evaluation - Economic
Evalua,on
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Unformatted text preview: Economic
Evalua,on
 Rashmi
Nair
 Objec,ves
of
Economic
Evalua,on
 •  Iden%fy,
measure,
and
value
the
compara%ve
 costs
and
effects
of
alterna%ve
health
care
 interven%ons
 •  The
4
common
economic
evalua%ons
are:
 –  Cost
minimiza%on
analysis
(CMA)
 –  Cost
effec%veness
analysis
(CEA)
 –  Cost
benefit
analysis
(CBA)
 –  Cost
u%lity
analysis
(CUA)
 Economic
Evalua,on
 •  A
full
economic
evalua,on
must:
 –  Consider
both
costs
and
consequences
 –  Consider
at
least
two
alterna,ve
interven,ons
 •  Resources
and
costs
are
measured
and
valued
 same
in
all
analysis
 Types
of
Pharmacoeconomic
Analysis
 METHODOLOGY
 CMA
 CEA
 COST
MEASUREMENT
 UNIT
 Dollars
or
monetary
units
 Dollars
or
monetary
units
 OUTCOME
MEASURMENT
 UNIT
 Assumed
to
be
equivalent
 in
comparable
groups
 Natural
units
(life
years
 gained,
mm
Hg
blood
 pressure,
mMol/L
blood
 glucose
 Dollars
or
monetary
units
 Quality
Adjusted
life
year
 (QALY)
or
other
u,li,es
 CBA
 CUA
 Dollars
or
monetary
units
 Dollars
or
monetary
units
 Source:
Essen,als
of
Pharmacoeconomics,
Karen
Rasca,
 CMA
 •  Simplest
to
conduct
 –  Outcomes
are
assumed
to
be
equivalent
 –  Only
costs
of
the
interven,on
are
compared
 •  Advantages
of
CMA
is
also
its
disadvantage
 –  Cannot
be
used
when
outcomes
of
interven,ons
 are
different
 •  Example:
brand
name
drugs
compared
to
 generics
 CEA
 •  Measures
outcomes
in
natural
units

 •  Example:
 –  mmHg,

 –  Cholesterol
levels,

 –  Symptom
free
days
(SFD)
 –  Years
of
life
saved
 CEA
 •  Advantage:
 –  Outcomes
are
easier
to
quan,fy
when
compared
 with
a
CUA
or
CBA
 –  Clinicians
are
familiar
with
measuring
these
types
 of
health
outcomes
 –  Rou,nely
collected
in
clinical
trials
and
in
clinical
 prac,ce
 CEA
 •  Disadvantages:
 –  Programs
with
different
types
of
outcomes
cannot
 be
compared
 –  Example:

 •  it
would
not
be
possible
to
compare
the
cost
 effec,veness
of
implemen,ng
an
an,coagula,on
clinic
 with
implemen,ng
a
diabetes
clinic
as
clinical
 outcomes
measured
would
be
valued
in
different
units
 •  Prothrombin

,me
versus
blood
glucose
measures
 CEA
 •  Disadvantages:
 –  Even
if
primary
clinical
outcome
unit
is
same
for
 the
alterna,ves,
if
there
are
major
differences
 •  Difficult
to
combine
the
differences
into
a
single
 effec,veness
measure


 –  CEA
may
es,mate
extra
costs
associated
with
each
 addi,onal
unit
outcome
(cure,
year
of
life,
SFDs)
 –  Who
is
to
say
if
added
costs
are
worth
added
 outcomes?
 CEA
 •  Disadvantages:
 –  No
monetary
amount
is
placed
on
the
clinical
 outcomes
to
indicate
the
value
of
these
outcomes
 –  It
is
a
judgment
call
by
pa,ent,
clinician,
or
 decision
maker
as
to
whether
the
alterna,ve
is
 “cost
effec,ve”
in
their
view

 CUA
 •  Some
CEA
comparisons,
such
as
evalua,ons
of
 chemotherapy
agents,
the
primary
clinical
unit
 measure
of
effec,veness
is
the
number
of
 years
of
life
gained
because
of
treatment.
 •  BUT,
just
measuring
a
pa,ent's
length
of
life
 because
of
treatment
does
not
take
into
 account
the
“quality”
or
“u,lity”
of
those
 years
 CUA
 •  Measures
outcomes
based
on
years
of
life
that
 are
adjusted
by
u,lity
weights
which
range
 from
1.0
for
“perfect
health”
to
0.0
for
“dead”
 •  These
u,lity
weights
incorporate
pa,ent
or
 society
preferences
for
specific
health
states
 •  Morbidity
and
mortality
are
both
important
 outcomes
of
a
treatment
 –  CUA
incorporates
both
into
one
unit
of
measure
 CUA
 •  Disadvantage:
 –  There
is
no
consensus
on
how
to
measure
these
 u,lity
weights
 –  They
are
more
of
a
rough
es,mate
than
a
precise
 measure
 •  Some
researchers
consider
CUA
as
a
subset
of
 CEA
 CBA
 •  CBA
is
unique,
Not
only
are
cost
valued
in
 monetary
terms,
so
are
benefits
 Advantages:
 •  Clinicians
and
other
decision
makers
can
 determine
whether
the
benefits
of
a
program
 or
interven,on
exceed
the
costs
of
 implementa,on
 CBA
 •  Advantages:
 –  Clinicians
and
other
decision
makers
can
compare
 mul,ple
programs
or
interven,ons
with
similar
or
 unrelated
outcomes
 –  Since
a
dollar
amount
is
es,mated
and
used
to
 place
a
value
on
health
outcomes,
the
answer
to
 “Is
the
alterna,ve
cost
beneficial?”
is
less
 subjec,ve
 CBA
 •  Disadvantage:
 –  Difficult
to
place
a
monetary
value
on
health
 outcomes
 –  Different
methods
used
to
es,mate
the
value
of
 health
outcomes,
and
similar
to
the
measurement
 of
u,li,es
 –  Different
methods
of
measurement
elicit
different
 es,mates
 •  These
es,mates
can
be
imprecise
 Costs
 •  Direct
costs
 –  Direct
medical
costs
 –  Direct
nonmedical
costs
 •  Indirect
costs
 •  Intangible
costs
 Direct
Medical
Costs
 •  Most
obvious
costs
to
measure
 •  These
are
the
medically
related
inputs
used
 directly
to
provide
the
treatment
 •  Examples:
 –  Medica,ons,
medica,on
monitoring,
 –  Pa,ent
counseling
and
consulta,ons
 –  Hospitaliza,ons,
clinic
visits,
home
medical
visits
 –  Ambulance
services,
nursing
services,
diagnos,c
 tests
 Direct
Nonmedical
Costs
 •  Costs
to
pa,ents
and
their
families
that
are
 directly
associated
with
treatment
but
are
not
 medical
in
nature
 •  Examples:
 –  Travel
costs
to
receive
health
care
(bus,
gas,
taxi)
 –  Non
medical
assistance
related
to
condi,on
(e.g.,
 meals
on
wheels,
homemaking
service)
 –  Hotel
stays
for
pa,ent
or
family
for
out‐of‐town
care
 –  Child
care
services
for
children
of
pa,ents
 Indirect
Costs
 •  Involve
the
costs
that
result
from
the
loss
of
 produc,vity
because
of
illness
or
death
 •  Indirect
benefits,
which
are
savings
because
of
 avoiding
indirect
costs
are
the
increased
 earnings
or
produc,vity
gains
that
occur
 because
of
the
medical
product
or
 interven,on
 Indirect
Costs
 •  Example:
 –  Lost
produc,vity
for
pa,ent
 –  Lost
produc,vity
for
unpaid
giver
(e.g.,
family
 member,
neighbor,
friend)
 –  Lost
produc,vity
because
of
premature
mortality
 Intangible
Costs
 •  Include
the
costs
of
pain,
suffering,
anxiety,
or
 fa,gue
that
occurs
because
of
an
illness
or
the
 treatment
of
an
illness
 •  Intangible
benefits,
which
are
avoidance
or
 allevia,on
of
intangible
costs,
are
benefits
 that
result
from
a
reduc,on
in
pain
and
 suffering
related
to
a
product
or
interven,on.
 •  Difficult
to
measure
or
place
a
monetary
value
 on
these
type
of
costs
 ...
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