Lecture 10: Economic evaluation Flashcards

1
Q

Why conduct economic evaluations?

A

Resources (time, money) in health promotion are scarce

“To fund or not to fund?”

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2
Q

Main question in economic evaluation?

A

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?

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3
Q

Define economic evaluation

A

Economic evaluation can be defined as a comparative analysis of the costs and consequences of alternative programs or intervention

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4
Q

Name the four types of economic evaluations

A
  1. Cost-effectiveness analysis
  2. Cost-utility analysis
  3. Cost-benefit analysis
  4. Cost-minimization analysis
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5
Q

What is done in a cost-effectiveness analysis?

A

Disease specific outcomes versus cost
- Measured in the same way as in the effect analysis

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6
Q

What is done in a cost-utility analysis?

A

QALYs and DALYs versus cost
- Measured in terms of utilities (QALYs and DALYs)

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7
Q

What is done is a cost-benefit analysis?

A

Effects converted to monitary values
- E.g., cost for day(s) of abstence from work due to sickness

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8
Q

What is done is a cost-minimization analysis?

A

Is used to compare the costs of interventions but only when we can reasonably assume that the effects of the interventions are the same!

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9
Q

What are the steps of an economic evaluation?

A
  1. Identification of the perspective
  2. Identification of the alternatives
  3. Identification, measurement and valuation of effects
  4. Identifycation, measurement and valuation of costs
  5. Statistical analysis
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10
Q

1: Identification of the perspective

A
  • 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.)
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11
Q

2: Identification of the alternatives

A

Intervention versus usual care / no intervention/ best available alternative

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12
Q

3: Identification, measurement and valuation of the effects

A
  • Cost-effectiveness analysis
  • Cost-utility analysis
  • Cost-benefit analysis
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13
Q

What is QALYs?

A

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)
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14
Q

How are the QALYs measured?

A
  1. Measure health state using the EQ-5D-3L
  2. Calculate utility (using Dutch value set)
  3. Calculate adjusted life years = Number of life years * utility score (0-1)
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15
Q

What life aspects are assessed with the EQ-5D-3L?

A
  1. Mobility
  2. Self-care
  3. Usual activities
  4. Pain/ discomfort
  5. Anxiety/ depression
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16
Q

4: Identification, measurement and valuation of the costs: what are relevant cost categories?

A
  • Health care costs
  • Patient costs
  • Costs in other sectors
  • Healthcare costs in life years gained

Zorginstituut Nederland heeft een richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg

17
Q

4: Identification, measurement and valuation of the costs: How to estimate costst?

A

Step 1: Measure resources consumed
Step 2: Collect unit price data
Step 3: Calculate costs: resources consumed x unit prices

All costs should be converted to the same reference year using “consumer price indices”

18
Q

Interventions costs: bottom up versus top down

A

Bottum-up
- Detailed data are collected regarding the quantity of resources consumed (step 1) and their unit prices (step 2), after which costs are calculated by multiplying them (step 3)

Top-down
- Intervenion costs based on invoices (facturen/ rekeningen)

19
Q

Determining healthcare costs (cost, resources and unit prices)

A

Cost
- medical

Resources
- Cost diaries
- Reptrospective questionnaires
- Insurance data
- Interviews

Unit prices
- Dutch manual of costing
- Prices professional organizations
- Bottum-up micro-costed

20
Q

Determining patient costs (cost, resources and unit prices)

A

Cost
- Travelling

Resources
- Cost diaries

Unit prices
- Dutch manual of costing

21
Q

Determining costs of other sectors (resources and unit prices for sickness absence and presenteeism)

A

Resources
- WHO-HPQ
- PRODISCQ
- company records

Unit prices
- Self-reported salaries
- Company records

22
Q

5: Statistical analysis (cost effectiveness analysis)

What are the steps?

A
  1. Calculate the effect difference
  2. Calculate the cost difference
  3. Calculate the ICER/ UCER

ICER = incremental
UCER = utility

23
Q

What is the ICER?

A

Incremental Cost-effectiveness ratio (costs per unit of effect gained)

Provides a number “on average per person”

Can be plotted on the Cost-effectiveness plane

24
Q

When is an intervention cost effective (effectiveness plane)?

A

NE: More effective and more costly (/)
SE: More effective and less costly (+)
NW: Less effective and more costly (-)
SW: Less effective and less costly (/)

25
Q

What are benefits?

A

Program oucomes converted into monetary values

  • (e.g., reduce sickness absence, improved work productivity)
26
Q

What is NB?

A

Net Benefits = benefit - cost
- Net savings/ loss
- Cost-beneficial when NB > 0

27
Q

What is BCR?

A

Benefit Cost Ratio = benefits/ cost
- Amount of money returend per Euro investment
- Cost beneficial when BCR > 1

28
Q

What is ROI?

A

Return On Investment = (benefit-cost)/ cost * 100%
- Percentage of profit per Euro invested
- Cost-beneficial when ROI > 0