Lecture 9 Economic evaluations of health promotion programs Flashcards
What is an economic evaluation and what are two reasons to conduct one?
Do the results of an intervention warrant its implementation, compared with the results from other interventions that could have been implemented using the same resources
Reasons: Because resources (time, money) for health promotion are scarce Whether or not you it is worth putting money into an intervention
What are the different types of economic evaluations?
- Cost-effectiveness analysis
- Cost-utility analysis
- Cost-benefit analysis
- Cost-minimisation analysis
Which five steps do you have to take when you are doing an economic evaluation?
- Identification of the perspective
- Identification of the alternatives
- Identification, measurement, and valuation of effects
- Identification, measurement and valuation of costs
- Statistical analysis
What is the ideal perspective when doing step 1 of an economic evaluation?
Societal perspective: All costs and consequences are taken into account irrespective of who pays or benefits from them
Above is the ideal situation, usually not the way day-to-day decisions are made.
Therefore look at other perspectives may also be relevant. For example, health care, employer, patient, etc.
What can be alternative interventions you can compare your own intervention to in step 2 of the economic evaluation?
- Usual care
- Best available alternative
- No intervention
What are types of analysis to measure, identify and valuate effects in step 3 of an economic evaluation?
For example the:
- Cost-effectiveness analysis
- Measured in the same way as in the effect analysis
- Cost-utility analysis
- Measured in terms of utilities (e.g. QALYs/ DALYs)
- Cost-benefit analysis
- Converted to monetary values
What are QALY’s?
Quality Adjusted Life Years
- Part of cost-utility analysis
- Number of life years, adjusted for health status during those years
Name three ways to measure QALYs
- Measures health state (EQ-5D-3L)
- Measurement tool: mobility, self-care, usual activities, pain/discomfort, anxiety/depression
- Calculate utility (Dutch value set)
- EQ-5D scores –> utility
- (11111 - 33333) –> (0-1)
- Calculate QALY
- Number of life years * utility = QALY
- Living 3 years w/ a mean utility of 0.7
- 3 * 0.7 = 2.1
What are relevant costs categories when carrying out step 4 of the economic evaluation?
- Healthcare costs
- Patient costs (over the counter medication e.g. paracetamol)
- Costs in other sectors
- Healthcare costs in life years gained
Which costs are included in both the societal perspective and the healthcare perspectives. Which two categories of costs differ?
Societal perspective
- Healthcare costs
- Patient costs
- Costs in other sectors
- Healthcare costs in life-years gained
Healthcare perspective
- Healthcare costs
- Healthcare costs in life-years gained
How do you measure and estimate costs? Name the three steps.
Step 1. Measure resources consumed
- How often did a person go to the GP
- How many sick days
- -> More useful than asking a person about their costs
Step 2. Collect unit price data
Step 3. Calculate costs
- Resources consumed * unit prices
KEEP IN MIND INFLATION –> because of this all units must be converted to the same reference year.
What are bottom-up and top-down intervention costs
Bottom up:
* Detailed data is collected regarding the quantity of resources consumed (step 1) as well as their unit prices (step 2). Subsequently, costs are calculated by multiplying them (step 3).
Top-down:
* Intervention costs are based on invoices, etc (step 1/2/3)
New interventions are harder to estimate (no price tags yet)
What are the three steps in a cost-effectiveness analysis (statistical analysis)
- calculate effect difference
- Calculate cost difference
- Calculate ICER
What is the Incremental cost-effectiveness ratio (ICER) and how do you calculate it? Give an interpretation.
Part of the cost-effectiveness analysis
Is the costs per unit of effect (gained)
Costs.intervention - costs.control Costs
———————————————— = ———- = ICER
Effect.intervention - Effect.control Effect
Interpretation:
X euro’s are needed to be invested in the intervention group in comparison to the control group to lose/gain a X unit of the outcome.
What is a cost-effectiveness plane
Incremental costs
NW: less effective, more costly (left top) = not cost effective
NE: more effective, more costly (right top) = ICER < willingness to pay
SW: less effective, less costly (left bottom) = ICER > willingness to pay
SE: more effective, less costly (right bottom) = cost effective
