Title: Interactive session design cost effectiveness
1Interactive 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/
2Questions 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?
3The 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
4When to evaluated?
5Tariffs
- 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
6Cost 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)
7We 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?
8How 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
9QALY league table
10Visual 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
11Time 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
12The 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
13Validated Questionnaires
- Describe health states
- Have values from the general public
- Rosser
- QWB
- 15D
- HUI Mark 2
- HUI Mark 3
- EuroQol EQ-5D
14Patient Perspective
15The Societal Perspective
16How 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.
17An 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.
18Some 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
19Some 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
20Outcome 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
21Trial 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
22Trial 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
23Modelling depression
Cure
Depressive patient Sex Age Number of
relapses Duration of illness
suicide
Natural death
Still depressive
24Books
- 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