Making Cost Effectiveness Analyses more useful: Budget Impact Curves Christopher McCabe PhD Endowed...
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Transcript of Making Cost Effectiveness Analyses more useful: Budget Impact Curves Christopher McCabe PhD Endowed...
Making Cost Effectiveness Analyses more useful: Budget Impact Curves
Christopher McCabe PhDEndowed Research Chair in Emergency
Medicine ResearchUniversity of Alberta
Acknowledgements
Funded by Genome Canada, Canadian Institutes for Health Research, Alberta Innovates Health Solutions, Capital Health Research Chair Endowment, UK National Institute for Health Research.
Co-authors: Klemens Wallner
Overview
• The evolution of outputs from Cost Effectiveness Analysis (CEA)
• Synthesis and aggregation in CEA• Meeting decision makers information needs• Introducing Budget Impact Curves (BICs)• An illustrative application of Budget Impact
Curves in a Risk Sharing Scheme• Budget Impact Curves: moving HTA towards
procurement
The evolution of outputs from CEA
Incremental Cost Effectiveness Ratios
Incremental Cost Effectiveness Plane
Confidence intervals in the cost effectiveness plane
Cost Effectiveness Acceptability Curves
Net Monetary and Net Health Benefit
The evolution of outputs from CEAExpected Value of Perfect Information
Expected Value of Partial Perfect Information
Expected Value of Sample Information
Expected Net Benefit of Sampling
Expected Net Present Value of Sample Information
Net Benefit Probability Maps
Increasingly sophisticated characterisation of the aggregate effect of introducing a new technology.
Maybe its time for something different.
Synthesis and aggregation
Cost effectiveness models “…synthesize evidence on health consequences and costs from many different sources including data from clinical trials, observational studies, insurance claims databases, case registries, public health statistics and preference surveys….(in) a logical mathematical framework that permits the integration of facts and values …link these data to outcomes that are of interest to decision makers”
Weinstein et al ViH 2003.
Synthesising evidence
“An ICER of £16,487 for concurrent treatment versus no trastuzumab.” Hall et al PharmacoEconomics 2011
Meeting Decision Makers Information Needs
• There are (at least) as many decision makers as there are budget holders.
• Most technologies impact on multiple budgets– CEA’s obsession with describing the aggregate
impact implicitly assumes there is only one budget• What if CEA gave budget specific information?
Introducing Budget Impact Curves• Budget Impact Curves (CICs) report the expected impact of a new
technology on specific budgets by capturing disaggregate cost information that is used in the calculation of the conventional aggregate CEA outputs.
• With time on the horizontal axis and cost on the vertical axis, BICs plot the expected incremental cost for specific budgets – such as the hospital budget or the pharmacy budget, over the time horizon of the model.
• Probability contours are used to plot the uncertainty in the budget impact estimates.
• BICs can be used to plot either the per-period or the cumulative budget impact.
• Budget holders can use the information provided to monitor actual budget impact against predictions, to help assess whether the promised value is actually being delivered.
Budget Impact Curve
An illustrative model
Cost ParametersParameter Stochastic Random Dist Param 1 Param 2
Chronic, silent disease total 29.03$ Chronic, silent disease Primary Care 14.35$ 0.426 LogNormal 2.71 0.23
Chronic, silent disease Pharmacy 14.67$ 0.846 LogNormal 2.54 0.14Chronic, silent disease Hospitalisation 0.00$ 0.230 LogNormal -4.95 0.83
Chronic, active disease total 96.29$ Chronic, active disease primary care 27.58$ 0.995 LogNormal 2.71 0.23
Chronic, active disease Pharmacy 30.19$ 0.699 LogNormal 3.37 0.07Chronic, active disease hospitalisation 38.52$ 0.407 LogNormal 3.67 0.09
Complications Total Costs 469.63$ Complications Primary Care 12.63$ 0.232 Gamma 17.73 0.87
Complications Pharmacy Costs 31.16$ 0.840 Gamma 227.01 0.13Complications Hospitalisation 425.85$ 0.905 Gamma 358.26 1.11
c_TxA 38.00$ fixedc_TxB 400.00$ fixed
ICER = $50,094 per QALY
Budget Impact Curve: Primary Care
Budget Impact Curve: Hospitals
Tolerance range
Contract review point
Price reduction
ICER = $18,125 per QALY
Moving HTA towards procurement
• Reimbursement assumes successful implementation• Procurement is key mechanism for effective
implementation• Standard HTA dossiers provide little if any useful
information to support procurement• Budget Impact Curves use information collected for
conventional cost effectiveness analyses to help budget holders
• BICs might be a first girder in the bridge between system level reimbursement and provider level procurement
http://www.edmontonsun.com/2015/03/19/hicks-on-biz-groat-bridge-debacle-is-fascinating-but-trivial
Thank you