HTA - lecture 1 - introduction in HTA/ EE Flashcards
HTA definition
HTA is the systematic evaluation of properties, effects and/or impacts of health technologies and interventions. It covers both the direct, intended consequences of technologies and interventions and their indirect, unintended consequences.
~WHO definition
economic evaluations
- Economic evaluations provide insight costs and effects of:
o (new) interventions
o Compared with existing interventions
the six steps of performing an EE in health care
- study design
- costs: measuring and valuation
- benefits: measuring and valuation
- discounting
- sensitivity: analysis
- policy making
step 1: study design
a) perspective - who is going to pay?
b) choice of comparator
c) type of analyses
d) time horizon
a) perspective - who is going to pay?
two dominant perspectives
1. health care perspective
2. societal perspective
–> perspective determines which costs and effects to include in the assessment
health care perspective
costs and effects falling on health care budget
societal perspective
all relevant costs and effects (doesn’t matter within HC or not)
b) choice of comparator
- Most efficient alternative
o Selection of alternatives. (as comparator) is crucial
o Comparator: expensive? Then it depends on the old treatment whether it’s more expensive or not - Standard treatment
o You need to compare to standard treatment - Consider “no treatment”
- Placebo not preferred
o That is only happening in trials
You compare alternatives
c) type of analyses
- Only costs
- Cost minimization analysis (CMA)
- Effects are equal, focus on costs
- Cost and effects in monetary terms
- Cost benefit analysis (CBA) multiply health effects with a monetary terms and you compare it to the cost of the alternative
> Extremely difficult; natural outcomes/units (e.g. heart attacks avoided, readmissions) no monetary terms from literature available
> It’s about gaining/losing welfare - Costs in monetary terms, effects in natural units
- Cost-effectiveness analysis (CEA) –> e.g. how money do we have to pay for one infection or readmission of a patient
- Costs in monetary terms, effects in QALYs
- Cost-utility analysis (CUA) how much must we pay to gain one QALY?; officially not correct, but used a lot
d) time horizon
- All consequences must be taken into account
- Lifetime horizon, so till the people die
- Complex to do because you need to follow people for a long time
- How to do so?
- Randomised trial (RCT)
- Observational study
- Model (cohort or individual patient model)
- Combination
step 2: measuring and valuing costs
- identify all relevant cost items
- measure resource use
- value resource use
step 3: measuring and valuing effects
- identify, measure and value effects of interventions
- disease specific measures
- generic measures
step 4: discounting
- We have time preference for both costs and health effects.
- We want positive health effects now
- We want to postpone costs we rather pay later; welfare increasing, if we have to pay 100 in 10 years time, that is less than if we have to pay 100 today (investing, making more or use money) –> uncertainty: we want to have a treatment now; avoiding develop disease 20 years later (so, less value attached in the future)
- Costs later in time weight less –> welfare is increasing 100 euros now is less than 100 euros in ten years
- Effects later in time have less value –> a lot can change
step 5: uncertainty
- –> data limited data, extrapolate it –> uncertainty (10-20 years after follow-up study); demonstrate impact on the outcome
- The values used in economic evaluations are estimates
- Based on sample of population
- Uncertainty is associated with all estimates
- Sensitivity analysis to find out how sensitive cost-effectiveness outcomes are to changes in parameters
step 6: applying a decision rule
Calculate the ICER
When is an intervention cost-effective?
QALY threshold?
