Lecture 11: cost effectiveness/pharmacoeconomics

Question 1

How do you calculate if an intervention is cost-effective with CER?

Answer 1

CER=(costs-savings)/life years gained. E.g.
Influenza vaccination in non-chronically-ill elderly is not cost-saving! Net costs: €5,000 for 1000 elderly (Influenza-related hospitalization–incidence: 2 /1000/year: €5000. Vaccine–effectiveness of 50%: €10 –> C-S = €10,000 - €5000). Mortality: 0.2 per 1000 unvaccinated persons/year. average remaining life expectancy of 5 years per death. vaccine effectiveness for averting mortality: 50%. Assume 1000 elderly. CER = €5,000 / (0.50.25) = €10,000 per LYG

Question 2

What are direct and indirect costs related to pharmacoeconomics?

Answer 2

Direct costs: drug costs, hospital stay costs

Indirect costs: economic consequences of illness: sickness leave, dying before reaching pension age

Question 3

What are the different cost-effectiveness quadrants and which one(s) is/are desirable?

Answer 3

Treatments divided in quadrants: less effective and more costly, more effective and more costly, less effective and less costly, more effective and less costly. The acceptable quadrants are: more effective and less costly (ideal), more effective and more costly, less effective and less costly.

Question 4

What are the maximal additional costs(euros) per QALY for the different groups of diseases?

Answer 4

Dependent on burden of disease, there are different maximal additional costs(euros) per QALY:

0. 10-0.40 (mild): 20,000
1. 41-0.70 (moderate): 50,000
2. 71-1.00 (severe): 80,000

Question 5

What is the formula for the ICER?

Answer 5

ICER= (costs-savings)/(difference in QALYs)

Question 6

How is utility calculated?

Answer 6

Utility: (10- lifeyears in health condition willing to be traded for perfect health)/10

lifeyears in health condition willing to be traded for perfect health= e.g. prefer living 10 years in health state x to 5 years in perfect health (losing 5 years)?