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Interactive session design cost effectiveness

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Title: Intro QALY & need assessment Author: Busschbach Last modified by: Busschbach Created Date: 1/22/1997 6:29:32 AM Document presentation format – PowerPoint PPT presentation

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Title: Interactive session design cost effectiveness


1
Interactive session design cost effectiveness
  • Jan J. v. Busschbach, Ph.D.
  • Erasmus MC
  • Institute for Medical Psychology and
    PsychotherapyPO Box 17383000 DR Rotterdam31
    10 4087807J.vanbusschbach_at_erasmusmc.nl
  • Psychotherapeutic centre 'De Viersprong
  • PO Box 74660 AA Halsteren 31 164
    632200Jan.Busschbach_at_deviersprong.nl
  • Presentations can be found at
  • http//www.xs4all.nl/jannetvb/busschbach/

2
Questions to be solved
  • Who is the audience?
  • Whos perspective?
  • Should we evaluated at all?
  • What are the costs?
  • What are the effects?
  • How do effects relate to the costs in practice?
  • Model
  • Who to interpret the cost effectiveness ratio?

3
The societal perspective
  • Standard in health economics
  • Determine cost (and effects) from the societal
    viewpoint
  • Resource used by all parties concerned
  • The cost for society as a whole
  • No matter who paying
  • Other perspectives are possible
  • Insurance, government, hospital, patient,
    industry, doctor

4
When to evaluated?
5
Tariffs
  • Cutback operation, correction of anus anterior
  • Small operation
  • Halve hour
  • Tariff 1571 Euro
  • Posterior Saggital Anorectoplasty (PSARP)
  • Large operation
  • 3 to 5 hours
  • Tariff 374 Euro

6
Cost price investigations
  • Measure only volumes of major costs drivers
  • Estimated real market prices
  • One should include all resources used
  • The societal perspective
  • Shadow pricing
  • Tariffs are only used in health economics
  • If they are a reasonable accurate indication of
    the resources used
  • If they are a small proportion of the total costs
  • If they volumes do not contribute to the
    incremental costs
  • (the difference between to alternative programs)

7
We are in need of uni-dimensional effects
  • For instance
  • 10,000 .- 1 hip transplantation
  • 15,000 ,- 1 wheelchair
  • Costs can be compared
  • Are uni-dimensionaal
  • Effects are less easy to compare
  • Effects are multi-dimensional
  • How to make the effects also uni-dimensional?

8
How to make the effects uni-dimensional?
  • Three methods
  • Cost Benefit Analysis
  • Express effects in money
  • Cost Effectiveness Analysis
  • Focus on one effect
  • Cost per QALY Analysis (Utility)
  • QALY

9
QALY league table
10
Visual Analogue Scale
Normal health
  • VAS
  • Also called category scaling
  • From psychological research
  • How is your quality of life today ?
  • X marks the spot
  • Response in centimeters
  • Rescale to 0..1
  • Different anchor point possible
  • Normal health (1.0) versus dead (0.0)
  • Best imaginable health versusworse imaginable
    health

X
Dead
11
Time Trade-Off
  • TTO
  • Wheelchair
  • With a life expectancy 50 years
  • How many years would you trade-off for a cure?
  • Max. trade-off is 10 years
  • QALY(wheel) QALY(healthy)
  • Y V(wheel) Y V(healthy)
  • 50 V(wheel) 40 1
  • V(wheel) .8

12
The EuroQol EQ-5D
  • MOBILITY
  • I have no problems in walking about
  • I have some problems in walking about
  • I am confined to bed
  • SELF-CARE
  • I have no problems with self-care
  • I have some problems washing or dressing myself
  • I am unable to wash or dress myself
  • USUAL ACTIVITIES (e.g. work, study, housework
    family or leisure activities)
  • I have no problems with performing my usual
    activities
  • I have some problems with performing my usual
    activities
  • I am unable to perform my usual activities
  • PAIN/DISCOMFORT
  • I have no pain or discomfort
  • I have moderate pain or discomfort
  • I have extreme pain or discomfort
  • ANXIETY/DEPRESSION
  • I am not anxious or depressed
  • I am moderately anxious or depressed

13
Validated Questionnaires
  • Describe health states
  • Have values from the general public
  • Rosser
  • QWB
  • 15D
  • HUI Mark 2
  • HUI Mark 3
  • EuroQol EQ-5D

14
Patient Perspective
15
The Societal Perspective
16
How to get these societal values?
  • Patient fills in questionnaire
  • Choose the value function from the literature
  • Calculate societal value

COMPUTE MVH_A1 1. VARIABLE LABELS MVH_A1 'York
A1 tariff'. DO IF (NVALID(mo, sc, ua, pd, ad) lt
5 ). RECODE MVH_A1 (1 SYSMIS). END IF. IF
(MAX(mo, sc, ua, pd, ad) gt 1) MVH_A1 MVH_A1
-.081. IF (mo 2) MVH_A1 MVH_A1 - .069. IF (mo
3) MVH_A1 MVH_A1 - .314. IF (sc 2) MVH_A1
MVH_A1 - .104. IF (sc 3) MVH_A1 MVH_A1 -
.214. IF (ua 2) MVH_A1 MVH_A1 - .036. IF (ua
3) MVH_A1 MVH_A1 - .094. IF (pd 2) MVH_A1
MVH_A1 - .123. IF (pd 3) MVH_A1 MVH_A1 -
.386. IF (ad 2) MVH_A1 MVH_A1 - .071. IF (ad
3) MVH_A1 MVH_A1 - .236. IF (MAX(mo, sc, ua,
pd, ad) gt 2) MVH_A1 MVH_A1 - .269.
17
An example of a value function
SPSS syntax Dolan 1997, Medical Care,
1997351095-108. mo mobility, sc self care,
ua usual activities, pd pain discomfort ,
ad anxiety and depression. COMPUTE MVH_A1
1. VARIABLE LABELS MVH_A1 'York A1 tariff'. DO
IF (NVALID(mo, sc, ua, pd, ad) lt 5 ). RECODE
MVH_A1 (1 SYSMIS). END IF. IF (MAX(mo, sc, ua,
pd, ad) gt 1) MVH_A1 MVH_A1 -.081. IF (mo 2)
MVH_A1 MVH_A1 - .069. IF (mo 3) MVH_A1
MVH_A1 - .314. IF (sc 2) MVH_A1 MVH_A1 -
.104. IF (sc 3) MVH_A1 MVH_A1 - .214. IF (ua
2) MVH_A1 MVH_A1 - .036. IF (ua 3) MVH_A1
MVH_A1 - .094. IF (pd 2) MVH_A1 MVH_A1 -
.123. IF (pd 3) MVH_A1 MVH_A1 - .386. IF (ad
2) MVH_A1 MVH_A1 - .071. IF (ad 3) MVH_A1
MVH_A1 - .236. IF (MAX(mo, sc, ua, pd, ad) gt 2)
MVH_A1 MVH_A1 - .269.
18
Some values
  • Broken arm
  • 12211
  • no problems in walking about
  • some problems washing or dressing
  • some problems with performing usual activities
  • no pain or discomfort
  • not anxious or depressed
  • Societal value 0.779

19
Some values
  • Broken hip
  • 22222
  • some problems in walking about
  • some problems washing or dressing
  • some problems with performing usual activities
  • moderate pain or discomfort
  • moderately anxious or depressed
  • Societal value 0.516

20
Outcome Research
  • Clinical research
  • Does it work?
  • Efficacy
  • Perfect patient
  • No co morbidity
  • Randomized Clinical Trial
  • Controlled conditions
  • Outcome research
  • Does it work in practice
  • Effectiveness
  • Every day patient
  • Normal co morbidity
  • Trials in a naturalistic setting
  • Real life conditions

21
Trial versus Clinical Practise
  • Subject homogeneity
  • Double blind
  • Placebo comparison
  • Forced compliance
  • Fixed procedures
  • High motivation
  • Representativeness
  • Open treatment
  • Usual care
  • Real compliance
  • Flexible procedure
  • Daily motivation

22
Trial versus Clinical Practise
  • Validity
  • High internal
  • Low external
  • Increase validity by
  • Search for large deviations of practice
  • Model outcomes to practice
  • Modelling
  • Use trial effect
  • Add external elements
  • Validity
  • Log internal
  • High external
  • Increase validity by
  • Search for causal relations
  • Model outcomes to new situation
  • Modelling
  • Use natural history
  • Add effect

23
Modelling depression
Cure
Depressive patient Sex Age Number of
relapses Duration of illness
suicide
Natural death
Still depressive
24
Books
  • Oostenbrink, J. B., M. A. Koopmanschap, et al.
  • "Handleiding voor Kostenonderzoek. Methoden en
    Richtlijnprijzen voor Economische Evaluaties in
    de Gezondheidszorg. 2000, College voor
    Zorgverzekeringen
  • Rutten-van Mölken MPMH, Busschbach JJV, Rutten
    FFH.
  • Van Kosten tot Effecten Een Handleiding voor
    Evaluatiesstudies in de Gezondheidszorg. Elsevier
    Gezondheidszorg, Maassen, ISBN 90 352 2281 4.
    Zomer 2000
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