Cost-effectiveness Analysis: Overview; Developing an analysis Advanced Training in Clinical Research...

Cost-effectiveness Analysis: Cost-effectiveness Analysis: Overview; Developing an analysisOverview; Developing an analysis

Advanced Training in Clinical ResearchAdvanced Training in Clinical ResearchDCEA Lecture 3DCEA Lecture 3

Birgit Hansl, Ph.D. Birgit Hansl, Ph.D.

UCSF Institute for Health Policy StudiesUCSF Institute for Health Policy Studies

February 3, 2005February 3, 2005

Lecture ObjectivesLecture Objectives

To understand the uses and basic types of To understand the uses and basic types of economic evaluation, especially of CEAeconomic evaluation, especially of CEA

To understand the basic steps in conducting To understand the basic steps in conducting a CEAa CEA

Lecture overview

……prior lectures on clinical decision analysis prior lectures on clinical decision analysis assessed health outcomes. Now we will add assessed health outcomes. Now we will add costs.costs.

Lecture contents:Lecture contents:

I. Why is economic evaluation important? I. Why is economic evaluation important?

II. Overview of economic evaluation methods II. Overview of economic evaluation methods

III. CEA - Steps in conducting a CEAIII. CEA - Steps in conducting a CEA

IV. Example: plan for conducting a CEAIV. Example: plan for conducting a CEA

I. Why is economic evaluation important?I. Why is economic evaluation important?

Programme Consequences A

Costs A A

Costs B Comparator Consequences B

B

Choice

The purpose of economic evaluation is to The purpose of economic evaluation is to identify, measure, value, and compare the identify, measure, value, and compare the costs and consequences of alternative costs and consequences of alternative

interventions, strategies or policies.interventions, strategies or policies.

I. Why is economic evaluation important? cont.I. Why is economic evaluation important? cont.

Diagram illustrates:Diagram illustrates:

• Formulation in terms of a choice between competing Formulation in terms of a choice between competing alternativesalternatives

• Program of interest = Program A can be an active treatment Program of interest = Program A can be an active treatment or ‘do nothing’or ‘do nothing’

• Measuring and valuing costs and consequences A and BMeasuring and valuing costs and consequences A and B

• Rule for assessing programs A and B: difference in costs is Rule for assessing programs A and B: difference in costs is compared to difference in consequences compared to difference in consequences (incremental/marginal analysis)(incremental/marginal analysis)


Economic evaluations become increasingly Economic evaluations become increasingly important tools for providers, policy makers important tools for providers, policy makers and program managers for assisting in health and program managers for assisting in health services decision making.services decision making.

→ → use health care $ to do most good:use health care $ to do most good:efficient allocation can save lives and improve efficient allocation can save lives and improve healthhealth


ProvidersProviders

what is the price of a program? what is the price of a program? - we don’t like to spend money on interventions we don’t like to spend money on interventions

that don’t workthat don’t work- we want to know what interventions, especially we want to know what interventions, especially

new ones, will cost usnew ones, will cost us- often we want a comparative analysis of often we want a comparative analysis of

alternative programsalternative programs


Policy makersPolicy makers

resource allocation is a reality: within health resource allocation is a reality: within health care as among other social goods care as among other social goods - within given budgets we need to set prioritieswithin given budgets we need to set priorities

Program managerProgram manager

resources - people, time, facilities, equipment, and resources - people, time, facilities, equipment, and knowledge - are scarceknowledge - are scarce- choices must be made concerning their choices must be made concerning their

deploymentdeployment- we prefer organized consideration of factors we prefer organized consideration of factors

involved in decision to commit resources to one involved in decision to commit resources to one use instead of anotheruse instead of another

I. Why is economic evaluation important? cont. I. Why is economic evaluation important? cont.


1.1. Why a systematic analysis? Why a systematic analysis?

– Identify all relevant alternatives: often they already existIdentify all relevant alternatives: often they already exist

– Example: introducing a new center for chronic lung diseaseExample: introducing a new center for chronic lung disease

2.2. Why is the viewpoint of the analysis important?Why is the viewpoint of the analysis important?

– Viewpoints: patient, hospital, MoH, community, society…Viewpoints: patient, hospital, MoH, community, society…

– Example: TB treatment strategiesExample: TB treatment strategies

3.3. Why attempt to measure? Why attempt to measure?

– Judgment about value for money is based on measurement Judgment about value for money is based on measurement and comparison of output and costsand comparison of output and costs

– Explain: real program costs=opportunity costsExplain: real program costs=opportunity costs


Opportunity costsOpportunity costs

• What is sacrificed to do the intervention under consideration? What is sacrificed to do the intervention under consideration?

• = real cost of program is not $ amount appearing in program = real cost of program is not $ amount appearing in program budget, but health outcomes achievable in other programs budget, but health outcomes achievable in other programs which have been forgone by committing resources to the first which have been forgone by committing resources to the first programprogram

• E.g., “… putting the same money into diabetes careE.g., “… putting the same money into diabetes care would have yielded 25 quality-adjusted life years” would have yielded 25 quality-adjusted life years”

• EA seeks to calculate opportunity costs & compare it w/ EA seeks to calculate opportunity costs & compare it w/ program benefitsprogram benefits

II. Economic evaluations methodsII. Economic evaluations methods

General approach: Compare the consequences of health care General approach: Compare the consequences of health care programs with their costs.programs with their costs.

There are four main forms of economic evaluation:There are four main forms of economic evaluation:

1.1. Cost (minimization) analysis, CMACost (minimization) analysis, CMA

2.2. Cost-effectiveness analysis, CEACost-effectiveness analysis, CEA

3.3. Cost-utility analysis, CUACost-utility analysis, CUA

4.4. Cost-benefit analysis, CBACost-benefit analysis, CBA

Each deals with costs (=inputs), but consequences of health care Each deals with costs (=inputs), but consequences of health care programs (=outputs) are measured and valued differentlyprograms (=outputs) are measured and valued differently

Type of economic evaluation

Identification of consequences

Measurement, valuation of consequences

Measurement, valuation of costs

Example Article Comment

CMA CMA Identical output, same effectiveness

None USD

two programes of hernias surgery, one requires hospital admission the other not

Russell et al. (1977)

If effectiveness is not identical CMA equals CEA

CEA CEA Single output, but different effectiveness

Natural units: life-years gained, deaths averted, cases detected

USDtwo diagnostic strategies for deep vein thrombosis

Hull et al. (1981)

Any alternatives which have commen effect - no direct health effect nessecary

CUA CUA

Single or multiple output adjusted by health state / utility weights

Utility: Quality-adjusted life years

USD

before and after the introduction of a neonatal intensive care program for low-birth weight infants

Boyle et al. (1993)

Assesses quality of health gain, not just crude health gain measure

CBA CBA

Single or multiple output that need common denominator

USD, willingness-to -pay

USD

individual's willingness-to-pay for health benefits of new versus old anti-depressants

O'Brien et al. (1995)

Measurement problems limit range of benefits valued are addressed by willingness-to-ay approach

Recap:

CEA is a full economic evaluation where costs and consequences are examined

Assessment of a choice: 2+ courses of action are compared

Single output (=consequence) that varies in effectiveness

Multiple inputs (costs) are considered that differ

Marginal analysis: incremental gain in output (health status) achievable with incremental in increase in input (health care resources)

III. Cost-effectiveness analysis III. Cost-effectiveness analysis

III. Cost-effectiveness analysis - StepsIII. Cost-effectiveness analysis - Steps1.1. Define the audience for the evaluationDefine the audience for the evaluation

2.2. Define the problem in question to be analyzedDefine the problem in question to be analyzed

3.3. Indicate the strategies being evaluatedIndicate the strategies being evaluated

4.4. Specify the perspective of the analysisSpecify the perspective of the analysis

5.5. Define the relevant time frame and analytic horizonDefine the relevant time frame and analytic horizon

6.6. Determine whether the analysis is marginal or incrementalDetermine whether the analysis is marginal or incremental

7.7. Determine the analytic methodsDetermine the analytic methods

8.8. Identify relevant outcomesIdentify relevant outcomes

9.9. Identify relevant costsIdentify relevant costs

10.10. Specify the discount rateSpecify the discount rate

11.11. Identify sources of uncertainty and conduct a sensitivity analysisIdentify sources of uncertainty and conduct a sensitivity analysis

12.12. Determine the summary measure to be reportedDetermine the summary measure to be reported

13.13. Analyze distributional and ethical issuesAnalyze distributional and ethical issues

III. Cost-effectiveness analysis – cont.III. Cost-effectiveness analysis – cont.

Identify relevant outcomesIdentify relevant outcomes

→ → (2.)(2.) Define the problem in question to be analyzedDefine the problem in question to be analyzed→ → (3.) Indicate the strategies being evaluated(3.) Indicate the strategies being evaluated

The following conditions must hold:The following conditions must hold:

1.1. Clarify the one unambiguous objective of the program(s) and Clarify the one unambiguous objective of the program(s) and that there is a clear dimension along which effectiveness can be that there is a clear dimension along which effectiveness can be

assessedassessed

2.2. If there are many objectives and alternative interventions If there are many objectives and alternative interventions thought to achieve these to the same extent, i.e. have equivalent thought to achieve these to the same extent, i.e. have equivalent effectiveness, perform a cost-minimization analysiseffectiveness, perform a cost-minimization analysis

cont.cont.


cont.cont. Identify relevant outcomes Identify relevant outcomes

→ → (7.)(7.) Determine the analytic methodsDetermine the analytic methods → → (5.)(5.) Define the relevant time frame and analytic horizonDefine the relevant time frame and analytic horizon

3. 3. Keep open to the possibility of employing a more Keep open to the possibility of employing a more sophisticated sophisticated analysis (i.e. CUA, CBA)analysis (i.e. CUA, CBA)

• Lookout for Lookout for otherother attributes of the alternatives and report these attributes of the alternatives and report these extra dimensions, e.g. number of complicationsextra dimensions, e.g. number of complications

4. 4. Is the effectiveness measure a Is the effectiveness measure a final final or or intermediate intermediate health health output?output?

• Final: Final: life-years gained, cases of death averted, quality-life-years gained, cases of death averted, quality-adjusted life years (QALYs - adjusted life years (QALYs - life years*utility scores)life years*utility scores)

• Intermediate: Intermediate: cases detected, patients with completedcases detected, patients with completed treatmenttreatment


Logan et al. (1981) Logan et al. (1981) Hypertension treatmentHypertension treatment mmHg blood mmHg blood in in Hypertension Hypertension 3:2:211-183:2:211-18 pressure reductionpressure reduction

Hull et al. (1981)Hull et al. (1981) Diagnosis of deep-veinDiagnosis of deep-vein cases of DTV cases of DTV in N. Engl. J. Med. 304:1561-67 thrombosis detected

Sculpher and Buxton (1993)Sculpher and Buxton (1993) AsthmaAsthma episode-freeepisode-freeIn In PharmacoEconomicsPharmacoEconomics 4:5:345-52 4:5:345-52 daysdays

Mark et al. (1995)Mark et al. (1995) ThrombolysisThrombolysis years of lifeyears of lifeIn In N. Engl. J. Med. 332:21:1418-24 gainedgained

Examples of cost-effectiveness measures used in CEAExamples of cost-effectiveness measures used in CEA

Identify relevant inputsIdentify relevant inputs

→ → (1.) Define the audience for the evaluation(1.) Define the audience for the evaluation

→ → (4.) Specify the perspective of the analysis(4.) Specify the perspective of the analysis

1.1. Consider range of costsConsider range of costs Assess if you could consider a narrower range of costs, e.g. Assess if you could consider a narrower range of costs, e.g.

only operating costs in health sector and not also patient’s costsonly operating costs in health sector and not also patient’s costs Common costs to two programs/treatments under study can be Common costs to two programs/treatments under study can be

excluded (timesaver!)excluded (timesaver!)

2.2. Consider magnitude of costsConsider magnitude of costs Exclude minor costs that are unlikely to make a difference in Exclude minor costs that are unlikely to make a difference in

the study results (timesaver!)the study results (timesaver!)

cont.cont.


cont.cont. Identify relevant inputs Identify relevant inputs

→ → (1.) Define the audience for the evaluation(1.) Define the audience for the evaluation

→ → (4.) Specify the perspective of the analysis(4.) Specify the perspective of the analysis

→ → (5.)(5.) Define the relevant time frame and analytic horizonDefine the relevant time frame and analytic horizon

3. 3. Elements of costing: Elements of costing: C = p*q (p=price, q=quantities)C = p*q (p=price, q=quantities) Potential sources for the quantities range from standard to Potential sources for the quantities range from standard to

unusual, e.g. hospital records vs. patient’s diariesunusual, e.g. hospital records vs. patient’s diaries If prices are not reported (e.g. for donated goods, volunteer time, If prices are not reported (e.g. for donated goods, volunteer time,

and leisure time) always use market prices!and leisure time) always use market prices! Overhead costs - how to allocate shared resources?Overhead costs - how to allocate shared resources? Capital costs (equipment, buildings, land) – past investments in Capital costs (equipment, buildings, land) – past investments in

an asset used over time - depreciationan asset used over time - depreciationcont.cont.


III. Cost-effectiveness analysis – cont.III. Cost-effectiveness analysis – cont.cont.cont. Identify relevant inputs Identify relevant inputs

→ → (5.)(5.) Define the relevant time frame and analytic horizonDefine the relevant time frame and analytic horizon

4.4. Consider time frame over which costs should be trackedConsider time frame over which costs should be tracked Don’t forget inflation adjustments!Don’t forget inflation adjustments!

5. Marginal vs. Average costs – why is this significant?5. Marginal vs. Average costs – why is this significant? Various cost definitions…Various cost definitions…

Fixed costs (FC) - costs which do not vary with quantity of output in the short-term (e.g. salaries and rent)

Variable costs (VC) - costs which vary with the level of output (e.g. supplies and fees for services)

Total costs (TC) = FC + VC - costs of producing a particular quantity of output

Average costs (AC) = TC/q - average costs per unit of output

Marginal costs (MC) = (TC of x+1 units) - (TC of x units) - extra costs of producing one extra unit of output

III. Cost-effectiveness analysis – cont.III. Cost-effectiveness analysis – cont.cont.cont. Identify relevant inputs Identify relevant inputs

Example: savings associated with reduction in inpatient stayExample: savings associated with reduction in inpatient stay

Hospital costs can be considered to consist of two elements: (1) hotel costs, Hospital costs can be considered to consist of two elements: (1) hotel costs, constant over the length of stay and (2) treatment costs, which peak just after constant over the length of stay and (2) treatment costs, which peak just after admission and then tail offadmission and then tail off

III. Cost-effectiveness analysis – cont.III. Cost-effectiveness analysis – cont. Specify the discount rateSpecify the discount rate

Allowance needs to be made for the differential timing of Allowance needs to be made for the differential timing of costs and consequences. costs and consequences.

(Positive) Time Preference(Positive) Time Preference in economics: it is an advantage in economics: it is an advantage to receive a to receive a benefit earlierbenefit earlier or to incur a or to incur a cost latercost later

• Important when comparing programs with different time Important when comparing programs with different time profiles, e.g. prevention vs. treatment programs profiles, e.g. prevention vs. treatment programs

– Are prevention programs and other long-term Are prevention programs and other long-term investments penalized by discounting? investments penalized by discounting?

• Use discount rate (standard=5% or 3%) to adjust future Use discount rate (standard=5% or 3%) to adjust future costs and benefits to present values costs and benefits to present values

III. Cost-effectiveness analysis – cont.III. Cost-effectiveness analysis – cont. The CE Ratio:The CE Ratio:

increment in costs between two courses of actionincrement in costs between two courses of actiondivided bydivided by

the increment in health outcomesthe increment in health outcomes

E.g., cost of universal HIV prevention + targeted HIV prevention E.g., cost of universal HIV prevention + targeted HIV prevention minus cost of universal HIV prevention (alone), divided by the minus cost of universal HIV prevention (alone), divided by the difference in HIV infections prevented.difference in HIV infections prevented.

Cell III: Cell III: lessless expensive, expensive, moremore effective = effective = better! CE index irrelevant.better! CE index irrelevant.

Cell IICell II higherhigher cost, cost, lessless effective. effective. CE index not needed.CE index not needed.

Cells I, IV: Cells I, IV: trade-offtrade-off between cost and between cost and effectivenesseffectiveness. Need CE.. Need CE.

Incremental cost of program A

compared with program B

Less More

Incremental effectiveness

of program A compared Less I II

with program B

More III IV

III. Cost-effectiveness analysis – cont.III. Cost-effectiveness analysis – cont.Average and incremental CE Ratio:Average and incremental CE Ratio: Costs (USD) Effects Ratio Costs (USD) Effects Ratio

(C/E)(C/E)

(A) Universal HIV prevention (alone)(A) Universal HIV prevention (alone) 300,000300,000 201201 14931493

(B) A + Targeted HIV prevention(B) A + Targeted HIV prevention 800,000800,000 301301 39803980

Increment (of program B over A)Increment (of program B over A) 500,000500,000 100100 50005000

Desirability depends on cost / gain in health status, and threshold for paying for improved health.Desirability depends on cost / gain in health status, and threshold for paying for improved health.

Costs (C)(1,000 USD)

B (C=800,000)

600 (E=301)Average CE slope

3980 5000

300 A Incremental CE slope (C=300,000) (E=201)

1493

0 100 200 300 Effects (E)(HIV infections prevented)

IV. Example: plan for conducting a CEAIV. Example: plan for conducting a CEA

(1) (1) Define analysis.Define analysis.

DA: Clinical or policy situation, alternative strategies. DA: Clinical or policy situation, alternative strategies.

CEA: Financial perspective, CE outcome measures.CEA: Financial perspective, CE outcome measures.

(2) (2) Specify technical approach.Specify technical approach.

DA: decisionDA: decision tree, with chance nodes and utilities.tree, with chance nodes and utilities.

CEA: Cost outcomes, formulas for outcome measuresCEA: Cost outcomes, formulas for outcome measures

(3) (3) Determine input values.Determine input values.

DA: health values (chance node probabilities, utilities)DA: health values (chance node probabilities, utilities)

CEA: costs (for programs and medical care). CEA: costs (for programs and medical care).

(4) (4) Conduct analyses.Conduct analyses.

(5) (5) Prepare manuscriptsPrepare manuscripts

IV. Example: plan for conducting a CEA cont.IV. Example: plan for conducting a CEA cont.

(1) Define the analysis(1) Define the analysis

Aneurysm: clinical situation = woman, aged 50, with Aneurysm: clinical situation = woman, aged 50, with unruptured cerebral aneurysm found incidentally. unruptured cerebral aneurysm found incidentally. Options = no treatment or surgery (clipping).Options = no treatment or surgery (clipping).

Perspective = Perspective = societalsocietal. i.e. all costs counted, regardless of . i.e. all costs counted, regardless of who pays.who pays.

Outcome measure is Outcome measure is cost per QALY gainedcost per QALY gained.

This CEA compares surgical clipping to no treatment This CEA compares surgical clipping to no treatment for the management of an asymptomatic small cerebral for the management of an asymptomatic small cerebral aneurysm, for a 50 year old woman, estimating the societalaneurysm, for a 50 year old woman, estimating the societalcost per QALY gained.cost per QALY gained.


(2) Specify the technical approach(2) Specify the technical approach

QALYsdisc Costs

No aneurysm rupture0.9825

No surgery21.37 Die

Aneurysm rupture 0.45

0.0175 Survive0.55

No aneurysm ruptureDifference 1

Ä QALYs -1.63 Survive surg.0.902 Die

Aneurysm rupture 0.45

Clipping 0 Survive19.74 0.55

Key Inputs Surgery-induced disabilityRupture risk/yr 0.0005 0.075

Expected life span 35RR rupture w/ surgery 0 Surgical deathSurgical mortality 0.023 0.023Surg morb (disability) 0.075

0.0

Disability, shorter survival

SAH if reach hosp

SAH

$/yr, exp'd life

Surg

none

SAH if reach hosp

SAH

Surg

13.4

Ms. Brooks

13.3

21.4Normal survival,

worry

21.5

4.8

Immediate death

Normal survival,worry

21.4

Normal survival

Normal survival

Early death,worry

Early death

21.5


The cost per QALY gained is defined as:The cost per QALY gained is defined as:Cost with surgery - cost with no surgeryCost with surgery - cost with no surgery

QALYs with surgery - QALYs with no surgeryQALYs with surgery - QALYs with no surgery

Δ CostCostΔ QALYsQALYs

Formulation must be Formulation must be incrementalincremental:: from no intervention to from no intervention to intervention, or from lower cost to higher cost intervention.intervention, or from lower cost to higher cost intervention.

i.e.,i.e.,


(3) Determine input values(3) Determine input values

Health inputs specified previouslyHealth inputs specified previously. Here are key cost Here are key cost inputsinputs:

Cost inputCost input Value (range)Value (range) SourceSource

ClippingClipping $25,150 (18,000-35,000)$25,150 (18,000-35,000) Cohort study – Cohort study – cost accounting cost accounting systemsystem

Moderate/severe Moderate/severe disabilitydisability $20,000/yr (13,000-30,000)$20,000/yr (13,000-30,000) Published Published

estimateestimateSAH hospitalizationSAH hospitalization $47,000 ($33,000-$67,000)$47,000 ($33,000-$67,000) Cohort study – Cohort study –

cost accounting cost accounting systemsystem

Discount rateDiscount rate 3% (0-5)3% (0-5) CEA CEA guidelinesguidelinesMust be discounted… e.g., $47,000 for SAH hospitalization, average 17 years Must be discounted… e.g., $47,000 for SAH hospitalization, average 17 years

into the future, NPV = $35,912into the future, NPV = $35,912.


(3) Determine input values(3) Determine input valuesQALYs

discCost disc


No surgery21.37 Die

Aneurysm rupture 0.450.0175 Survive

0.55

No aneurysm ruptureDifference 1

Ä QALYs -1.63 Survive surg.0.902 Die

Aneurysm rupture 0.45Clipping 0 Survive

19.74 0.55Key Inputs Surgery-induced disabilityRupture risk/yr 0.0005 0.075Expected life span 35RR rupture w/ surgery 0 Surgical deathSurgical mortality 0.023 0.023Surg morb (disability) 0.075Cost of aneurysm hosp 47,000$

21.5

4.8

Immediate death


21.4

Normal survival

Normal survival

Early death,worry

Early death

21.5

13.4

Ms. Brooks

13.3


worry

-$

23,941$

35,912$

25,150$

49,091$

61,062$

218,700$

25,150$ 0.0



(4) Conduct analyses – How?(4) Conduct analyses – How?

• Calculate by hand: Calculate by hand: instructive once, inefficient and error-prone with instructive once, inefficient and error-prone with multiple calculationsmultiple calculations

• Calculate with spreadsheetsCalculate with spreadsheets: : flexible –any structure, input, flexible –any structure, input, calculation, outcome, or format, e.g., infectious disease epidemic calculation, outcome, or format, e.g., infectious disease epidemic modeling, or interacting Markov modelsmodeling, or interacting Markov modelsFor Monte Carlo and other sensitivity analyses, Crystal Ball. For Monte Carlo and other sensitivity analyses, Crystal Ball. Must program standard CEA tasks.Must program standard CEA tasks.

• Decision analysis packagesDecision analysis packages: : SMLTREE, DATA, TreeAge SMLTREE, DATA, TreeAge (http://www.treeage.com/products/download.html), etc. - designed (http://www.treeage.com/products/download.html), etc. - designed to do CEA tasks, e.g. trees, inputs, outputs, simple Markov, SA. to do CEA tasks, e.g. trees, inputs, outputs, simple Markov, SA. LLess flexible: CEA conforms to program structure, e.g. only 2-4 ess flexible: CEA conforms to program structure, e.g. only 2-4 outcomes, epidemic or complex Markov not possible. outcomes, epidemic or complex Markov not possible.


(5) (5) Prepare manuscriptsPrepare manuscripts

Presentation…Presentation… “Base case” for aneurysm analysis“Base case” for aneurysm analysis

QALYsdisc

Costdisc


No surgery21.37 Die$534 Aneurysm rupture 0.45

0.0175 Survive0.55

No aneurysm ruptureDifferences 1

Ä QALYs -1.63 Survive surg.Ä $ $39,132 0.902 Die

Aneurysm rupture 0.45Clipping 0 Survive

19.74 0.55Key Inputs $39,666 Surgery-induced disabilityRupture risk/yr 0.0005 0.075Expected life span 35RR rupture w/ surgery 0 Surgical deathSurgical mortality 0.023 0.023

Surg morb (disability) 0.075Cost of aneurysm hosp 47,000$

21.5

4.8

Immediate death


21.4

Normal survival

Normal survival

Early death,worry

Early death

21.5

13.4

Ms. Brooks

13.3


worry

-$

23,941$

35,912$

25,150$

Dominant Strategy

$ / QALY49,091$

61,062$

218,700$

25,150$ 0.0



(5) Prepare manuscripts(5) Prepare manuscripts Presentation…Presentation…

QALYsQALYs Costs CostsScenarioScenario TotalTotal AddedAdded TotalTotal AddedAdded $ / QALY $ / QALY

No symptoms, <10 mm, no past SAHNo symptoms, <10 mm, no past SAH

No treatmentNo treatment 21.3721.37 ---- $534$534 -- -- -- --

ClippingClipping 19.7419.74 -1.63-1.63 $39,666$39,666 $39,132 Dominated$39,132 Dominated


(5) Prepare manuscripts(5) Prepare manuscripts

Below are some of the formulas in the cellsBelow are some of the formulas in the cells

123456789

101112131415

A B C D E F G H I J K LQALYs

discCostdisc


No surgery =F3*K2+F7*(H6*K5+H8*K7) Die =F3*L2+F7*(H6*L5+H8*L7) Aneurysm rupture 0.45

0.0175 Survive0.55

No aneurysm ruptureDifferences 1

Ä QALYs =D17-D5 Survive surg.Ä $ =D18-D6 0.902 Die

$ / QALY =IF(B14/B13<0,"Dominant Strategy",B14/B13) Aneurysm rupture 0.45


21.4

Normal survival

Early death,worry

Early death

21.5

Ms. Brooks

13.3


worry

-$

23,941$

35,912$

25,150$

13.4 49,091$

SummarySummary

I. Why do CEA?I. Why do CEA? –make resource allocation decisions all the –make resource allocation decisions all the time, might as well be explicit about costs and to whomtime, might as well be explicit about costs and to whom

II. Overview of CEA II. Overview of CEA – health outcomes and cost inputs integral – health outcomes and cost inputs integral part of economic evaluations like CEApart of economic evaluations like CEA

III. CEA Steps III. CEA Steps – define; technical set-up; inputs and outputs; – define; technical set-up; inputs and outputs; analyses; presentationanalyses; presentation..

Next lectures:Next lectures: data inputs; sensitivity analyses; Markov simulationsdata inputs; sensitivity analyses; Markov simulations

Cost-effectiveness Analysis: Overview; Developing an analysis Advanced Training in Clinical Research...

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