Session 3 - Workshop

Brian Godman and Dr Alan HaycoxHealth Economics UnitUniversity of Liverpool Management

School

Onco-Pharmacoeconomy Training Onco-Pharmacoeconomy Training CourseCourse

Turkey ISPOR Training CourseTurkey ISPOR Training Course

As previously discussed on As previously discussed on resource Valuationresource Valuation

Average costsMarginal costsOpportunity

costs

A value is attached to each resource consumedResources can be valued differently…

Health economists and policy makers emphasise the importance of ‘opportunity costs’ in valuing overall expenditure as budgets are finite

As discussed, the most important As discussed, the most important concept in health economics is concept in health economics is Opportunity CostOpportunity CostThe opportunity cost of using resources

to produce a good or service is the benefits foregone from those resources not being used in their next best alternative. The concept of opportunity cost lies at the heart of all economic analyse

The health policy goal is to maximise patient outcomes with available resources. This means some benefits will be foregone – but these should be minimised

Case History – Adjuvant HERCEPTIN Case History – Adjuvant HERCEPTIN in Breast Cancer in one UK Hospitalin Breast Cancer in one UK HospitalCurrently 355 patients receive adjuvant

treatment in Norfolk and Norwich at GB£0.503mn/ year (16 cured at a cost/ cure ranging from £23000 - £137,000)

Treating 75 patients with early stage breast cancer with HERCEPTIN would cost GB£1.94mn/ year rising to GB£2.3mn with testing, monitoring and administration at a cost/ cure of £650,000

Finite budgets mean tough decisions need to be made on which treatments should be funded and which should be terminated or reduced

Ref: Barrett et al BMJ 2006

Costs and potential benefits of Costs and potential benefits of adjuvant cancer treatments in adjuvant cancer treatments in Norfolk HospitalNorfolk Hospital

Treatment and number of patients Drug cost (GB£000)

Cost/cured patient

(GB£000)

Adjuvant chemotherapy for lung cancer (15 patients)

23 23

Oxaliplatin as adjuvant therapy for colon cancer compared with fluorouracil alone (20 patients)

137 137

Neoadjuvant chemotherapy for oesophageal cancer (25 patients)

8 2.67

Rituximab in addition to CHOP for non-hodgkin lymphoma in patients over 60 (25)

215 71.67

Adjuvant aromatase inhibitors in postmenopausal breast cancer (270 patients) [NB drug costs will fall substantially in Europe once generics routinely available]

120 15

Total – 355 patients and 16 cured 503Ref: Barrett et al BMJ 2006

Workshop questions – based on the Workshop questions – based on the paper by Barrett et al in the BMJ in paper by Barrett et al in the BMJ in 20062006Should HERCEPTIN be funded for

use in adjuvant breast cancer patients in oncology units in Turkey?

If yes, and there are no additional funds, what patients should receive HERCEPTIN and how will this be paid for, i.e. what other treatment approaches will be reduced? This could be other technologies including drugs as well as personnel

Workshop logisticsWorkshop logistics

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