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Unformatted text preview: 7/7/2011 1 CHAPTER 9—COST- EFFECTIVENESS ANALYSIS 1 CASE STUDY 5 See work on excel document 2 INTRODUCTION o Resources available to healthcare are finite—why? o Opportunity cost of healthcare versus all else o Therefore want to use resources efficiently o Is use of healthcare worthwhile, given alternative uses? o Multiple outcomes make decisions hard 3 o Maximize five-year survival for cancer patients o Treatments affect more than mortality only o Affect morbidity and costs o Deciding between people even harder o Which diseases to focus on? o Ageism (nursing home quality or immunizations)? COST-EFFECTIVENESS ANALYSIS (CEA)— A TOOL FOR RESOURCE ALLOCATION o Assumption: not possible to provide all beneficial services to all people o How to control healthcare costs? 4 o Eliminate delivery inefficiencies o e.g., Inpatient outpatient o Weed out ineffective interventions o Are there other ways to control costs without reducing quality? TRADE-OFFS BETWEEN COST AND EFFECTIVENESS o Interventions that improve health and save money should be adopted o Interventions that decrease health and cost money should be eliminated 5 money should be eliminated o Other options require choices o What if improve health but cost money? o What if health decreases at a cost savings? o e.g., Effective interventions currently in place that achieve less benefit with $ than alternative uses TRADE OFF BETWEEN COSTS AND EFFECTS effects Superior + Trade off costs- + Trade-off Inferior- 6 7/7/2011 2 HOW TO EVALUATE TRADE-OFFS o Cost-minimization analysis o Compare interventions with same effectiveness solely on the basis of cost o Measure used is net difference in resource cost o Cost-effectiveness analysis (CEA) o Compare interventions using common measures of both cost ($) and effectiveness (e g disease prevented lives saved cases 7 ($) and effectiveness (e.g., disease prevented, lives saved, cases cured, years of life saved, QALYs) o If used quality-adjusted units (e.g., QALYs), call this analysis “cost-utility analysis” o Cost-benefit analysis (CBA) o Costs and benefits in $ o Can be used to compare very different interventions o Measure used is positive net benefit o Used less frequently because hard to value human life or quality of life PERSPECTIVES FOR ANALYSIS o Resource allocation decisions are made in the context of diverse views o Patient o Clinician o Policymaker 8 o CEA must specify decision-making perspective, e.g., patient or payer (e.g., HMO) or society o Society perspective is the largest and considers all ramifications (costs), regardless of who experiences them, and all benefits, regardless of who experiences them 9 CEA STEPS o Specify programs and perspectives o Define the program (frequency, intensity, etc.) o Frame the analysis o Perspective—patient, payer, society o Reference—doing nothing, status quo, comparison 10 program o Target population o Time horizon—when effects and side effects realized o Pick longest time horizon and discount o...
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This note was uploaded on 08/21/2011 for the course AHS 375 taught by Professor Elder during the Summer '11 term at University of Alabama at Birmingham.
- Summer '11