Health Economic Evaluations in Chronic Disease and Palliative Care

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Health Economic Evaluations in Chronic Disease
and Palliative Care

• Paul McCrone
• Kings College London

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Outline of Session

• Key components of economic evaluations
• Reviews of economic evaluations
• Costs of MS
• Costs of Parkinsons Disease
• Costs of Parkinsons Plus Syndromes
• Use of modelling in economic evaluations

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Key Components of Economic Evaluations

• Collection of service use data
• self-recall
• administrative systems
• Estimation of unit costs
• locally specific / nationally applicable
• issues of generalisability
• prices or costs?
• Analysis of cost data
• Outcome measurement
• relevance for clinicians and policy makers
• appropriateness for economic evaluations
• Synthesis of costs and outcomes
• Interpretation and use of findings

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Client Service Receipt Inventory (CSRI)

• Developed in late 1980s for evaluation of care in
  the community (learning difficulties) and
  hospital reprovision
• Used in 200 (?) studies in UK and abroad
• Specific adaptations for each study
• Data collected from carers, key-workers, patients
  or notes
• 20 minutes
• Retrospective period 1-12 months

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Review of Palliative Care in Hospital, Hospice
and Home (Finlay et al, 2002)

• Palliative care in hospital (n8)
• length of stay generally reduced
• costs not reported
• outcomes unaffected
• Home care (n22)
• outcomes usually better than for usual care
• costs (reported in 7 studies) were lower
• Hospice care hospice with home care (n9)
• outcomes usually better than usual care
• costs were reported in 1 study and were similar
  to control

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Review of Specialist Nursing Care (Douglas et al,
2003)

• 17 studies identified which reported costs and
  outcomes
• 4 studies focussed on cancer
• Limited range of costs included
• No cost-effectiveness ratios reported
• 1 study found better outcomes and same costs
• 2 studies found same outcomes and higher costs
• 1 study found better outcomes and lower costs

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Review of Palliative Care Teams (Higginson et al,
2003)

• 14 health economic studies identified
• 13 were cost studies
• 1 cost-utility analysis
• home intervention for patients with AIDS
• interventions was considered as cost-effective
• 3 studies adopted a societal perspective
• 2 studies attempted to assess the costs to
  patients and families
• Economic analysis had often been attempted when
  clinical benefit failed to be demonstrated,
  rather than measurement of utility and human
  welfare, linked to health-related outcomes, being
  incorporated in study design

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Review of Palliative Care for Advanced Dementia
(Sampson et al, 2005)

• Only 2 relevant controlled studies identified
• Volicer et al (1994)
• prospective cohort study of a dementia special
  care unit and usual care
• costs were lower for special care unit patients
  and discomfort was lower, but mortality rate was
  higher
• Ahronheim et al (2000)
• RCT of palliative care intervention
• no difference in costs or outcomes compared to
  usual care

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Costs of Multiple Sclerosis

• Questionnaire sent to random sample of 4000 MS
  Society members
• Around 2000 responders
• Four components
• sociodemographic questions
• quality of life assessment
• service use information
• disability assessment

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Service Costs by Type of MS
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Total Costs by Type of MS
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Variation in Costs
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Costs of Parkinsons Disease

• Prospective observational study
• Patients recruited from primary care and
  specialist clinics (total n174)
• Service use recorded
• primary care services
• secondary care
• tests/investigations
• medication
• informal care

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Service Costs by Stage of Parkinsons Disease
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Costs of Parkinsons Plus Syndromes

• Natural History Neuroprotection in Parkinson
  Plus Syndromes
• Two diseases
• multiple system atrophy (MSA)
• progressive supranuclear atrophy (PSP)
• 3 countries (France, Germany and UK), 50 sites,
  731 participants
• Service use measured at 0, 6, 12, 24 36 months
• Costs calculated using country specific data

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Service Costs by Time Point
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Informal Care as Proportion of Service Costs
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Use of Decision Models

• Trials and observational studies arguably provide
  the best data, but ....
• ... they are expensive and results are often not
  known for some time
• Decision models are an alternative way of
  producing information on the cost-effectiveness
  of interventions
• Data obtained from a variety of sources
• Generalisable

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Decision Model Example
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Summary

• Limited but growing number of economic
  evaluations of palliative care
• High costs associated with disease progression
• Cost of informal care substantial
• Decision models are a potential alternative to
  trials