Lecture 10: Economic evaluation Flashcards
Why conduct economic evaluations?
Resources (time, money) in health promotion are scarce
“To fund or not to fund?”
Main question in economic evaluation?
Do the results of an intervention warrant its implementation compared to the results from other interventions that could have been implemented using the same resources?
Define economic evaluation
Economic evaluation can be defined as a comparative analysis of the costs and consequences of alternative programs or intervention
Name the four types of economic evaluations
- Cost-effectiveness analysis
- Cost-utility analysis
- Cost-benefit analysis
- Cost-minimization analysis
What is done in a cost-effectiveness analysis?
Disease specific outcomes versus cost
- Measured in the same way as in the effect analysis
What is done in a cost-utility analysis?
QALYs and DALYs versus cost
- Measured in terms of utilities (QALYs and DALYs)
What is done is a cost-benefit analysis?
Effects converted to monitary values
- E.g., cost for day(s) of abstence from work due to sickness
What is done is a cost-minimization analysis?
Is used to compare the costs of interventions but only when we can reasonably assume that the effects of the interventions are the same!
What are the steps of an economic evaluation?
- Identification of the perspective
- Identification of the alternatives
- Identification, measurement and valuation of effects
- Identifycation, measurement and valuation of costs
- Statistical analysis
1: Identification of the perspective
- Ideally from a societal perspective; desicions are justified based on it’s consequences for all who are affected by it
- “However, this is rarely the way in which day to day desicions are made”
- Therefore other perspectives may also be relevant (healthcare, employer, patient, etc.)
2: Identification of the alternatives
Intervention versus usual care / no intervention/ best available alternative
3: Identification, measurement and valuation of the effects
- Cost-effectiveness analysis
- Cost-utility analysis
- Cost-benefit analysis
What is QALYs?
Quality Adjusted Life Years = The number of life years, adjusted for health status during those years
- QALYs is an health economic outcome (not a clinical outcome)
How are the QALYs measured?
- Measure health state using the EQ-5D-3L
- Calculate utility (using Dutch value set)
- Calculate adjusted life years = Number of life years * utility score (0-1)
What life aspects are assessed with the EQ-5D-3L?
- Mobility
- Self-care
- Usual activities
- Pain/ discomfort
- Anxiety/ depression